S.B. No. 1000
AN ACT
relating to the regulation of the practice of nursing.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subsections (b) and (c), Section 105.002, Health
and Safety Code, are amended to read as follows:
(b) In conjunction with the committee formed under Section
104.0155, to avoid duplication of effort, and to the extent funding
is available through fees collected under Section [Sections]
301.155(c) [and 302.153(d)], Occupations Code, the council shall
establish a nursing resource section within the center for the
collection and analysis of educational and employment trends for
nurses in this state.
(c) If the nursing resource section established under
Subsection (b) is funded from surcharges collected under Section
[Sections] 301.155(c) [and 302.153(d)], Occupations Code, the
council shall provide the Board of Nurse Examiners [and the Board of
Vocational Nurse Examiners, as applicable,] with an annual
accounting of the money received from the board [those boards]. The
council may expend a reasonable amount of the money to pay
administrative costs of maintaining the nursing resource section.
SECTION 2. Subsection (e), Section 105.003, Health and
Safety Code, is amended to read as follows:
(e) Data received under this section by the nursing resource
section established under Section 105.002 [department under this
section] that contains information identifying specific patients
[persons] or health care facilities is confidential, is not subject
to disclosure under Chapter 552, Government Code, and may not be
released unless all identifying information is removed.
SECTION 3. Subdivisions (2) and (5), Section 301.002,
Occupations Code, are amended to read as follows:
(2) "Professional nursing" means the performance [for
compensation] 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. The term does not include
acts of medical diagnosis or the prescription of therapeutic or
corrective measures. Professional nursing involves:
(A) 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;
(B) the maintenance of health or prevention of
illness;
(C) the administration of a medication or
treatment as ordered by a physician, podiatrist, or dentist;
(D) the supervision or teaching of nursing;
(E) the administration, supervision, and
evaluation of nursing practices, policies, and procedures;
(F) the requesting, receiving, signing for, and
distribution of prescription drug samples to patients at sites in
which a registered nurse is authorized to sign prescription drug
orders as provided by Subchapter B, Chapter 157; [and]
(G) the performance of an act delegated by a
physician under Section 157.052, 157.053, 157.054, 157.0541,
157.0542, 157.058, or 157.059; and
(H) the development of the nursing care plan.
(5) "Vocational nursing" means 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:
(A) collecting data and performing focused
nursing assessments of the health status of an individual;
(B) participating in the planning of the nursing
care needs of an individual;
(C) participating in the development and
modification of the nursing care plan;
(D) participating in health teaching and
counseling to promote, attain, and maintain the optimum health
level of an individual;
(E) assisting in the evaluation of an
individual's response to a nursing intervention and the
identification of an individual's needs; and
(F) engaging in other acts that require education
and training, as prescribed by board rules and policies,
commensurate with the nurse's experience, continuing education,
and demonstrated competency[, other than professional nursing,
that generally requires experience and education in biological,
physical, and social sciences sufficient to qualify as a licensed
vocational nurse].
SECTION 4. Subsection (c), Section 301.155, Occupations
Code, is amended to read as follows:
(c) The board shall assess a $3 surcharge for a registered
nurse and a $2 surcharge for a vocational nurse to the fee
established by the board under Subsection (a) for a license holder
to renew a license under this chapter. The board may use nine cents
of the registered nurse surcharge and six cents of the vocational
nurse surcharge to cover the administrative costs of collecting and
depositing the surcharge. The board quarterly shall transmit the
remainder [$2.91] of each [the] surcharge to the [Texas] Department
of State Health Services to be used only to implement the nursing
resource section under Section 105.002, Health and Safety Code.
The board is not required to collect the surcharge if the board
determines the funds collected are not appropriated for the purpose
of funding the nursing resource section.
SECTION 5. Subsections (c) and (d), Section 301.251,
Occupations Code, are amended to read as follows:
(c) This section does not apply to a person entitled to
practice [professional] nursing [or vocational nursing] in this
state under Chapter 304[, as added by Chapter 1420, Acts of the 77th
Legislature, Regular Session, 2001].
(d) Unless the person holds a license under this chapter [or
as a vocational nurse under Chapter 302], a person may not use, in
connection with the person's name:
(1) the title "nurse"; or
(2) any other designation tending to imply that the
person is licensed to provide nursing care.
SECTION 6. Section 301.351, Occupations Code, as amended by
Section 1.027, Chapter 553, Acts of the 78th Legislature, Regular
Session, 2003, and Section 5, Chapter 876, Acts of the 78th
Legislature, Regular Session, 2003, is reenacted and amended to
read as follows:
Sec. 301.351. DESIGNATIONS. (a) A person who holds a
license as a registered nurse under this chapter:
(1) is referred to as a registered nurse; and
(2) may use the abbreviation "R.N."
(b) A person who holds a license as a vocational nurse under
this chapter:
(1) is referred to as a licensed vocational nurse or
vocational nurse; and
(2) may use the abbreviation "L.V.N." or "V.N."
(c) While interacting with the public in a [professional]
nursing role, each [licensed registered] nurse shall wear a clearly
legible insignia identifying the nurse as a registered or
vocational nurse [and each licensed vocational nurse shall wear an
insignia identifying the nurse as a vocational nurse]. The
insignia may not contain information other than:
(1) the registered or vocational nurse designation;
(2) the nurse's name, certifications, academic
degrees, or practice position;
(3) the name of the employing facility or agency, or
other employer;
(4) a picture of the nurse; or
(5) any other information authorized by the board.
(d) [(c)] The board may adopt rules establishing
specifications for the insignia.
SECTION 7. Section 301.352, Occupations Code, is amended by
amending Subsections (a) and (b) and adding Subsection (e) to read
as follows:
(a) A person may not suspend, terminate, or otherwise
discipline or discriminate against a nurse who refuses to engage in
an act or omission relating to patient care that would constitute
grounds for reporting the nurse to the board under Subchapter I,
that constitutes a minor incident, or that violates this chapter or
a board rule if the nurse notifies the person at the time of the
refusal that the reason for refusing is that the act or omission:
(1) constitutes grounds for reporting the nurse to the
board; or
(2) is a violation of this chapter or a rule of the
board.
(b) An act by a person under Subsection (a) does not
constitute a violation of this section if a nursing peer review
committee under Chapter 303 determines:
(1) that the act or omission the nurse refused to
engage in was:
(A) not conduct reportable to the board under
Section 301.403;
(B) a minor incident; or
(C) a violation of this chapter or a board rule;
or
(2) that:
(A) the act or omission in which the nurse
refused to engage was conduct reportable to the board, a minor
incident, or a violation of this chapter or a board rule; and
(B) the person:
(i) rescinds any disciplinary or
discriminatory action taken against the nurse;
(ii) compensates the nurse for lost wages;
and
(iii) restores to the nurse any lost
benefits.
(e) In this section, "minor incident" has the meaning
assigned by Section 301.419.
SECTION 8. Subchapter H, Chapter 301, Occupations Code, is
amended by adding Section 301.353 to read as follows:
Sec. 301.353. SUPERVISION OF VOCATIONAL NURSE. The
practice of vocational nursing must be performed under the
supervision of a registered nurse, physician, physician assistant,
podiatrist, or dentist.
SECTION 9. Subsection (a), Section 301.401, Occupations
Code, is amended to read as follows:
(a) Except as provided by Subsection (b), the following are
grounds for reporting a nurse under Section 301.402, 301.403,
301.405, or 301.407:
(1) [unnecessary or] likely exposure by the nurse of a
patient or other person to an unnecessary [a] risk of harm;
(2) unprofessional conduct by the nurse;
(3) failure by the nurse to adequately care for a
patient;
(4) failure by the nurse to conform to the minimum
standards of acceptable [professional] nursing practice; or
(5) impairment or likely impairment of the nurse's
practice by chemical dependency.
SECTION 10. Subsections (c) and (f), Section 301.402,
Occupations Code, are amended to read as follows:
(c) In a written, signed report to the appropriate licensing
board or accrediting body, a nurse may report a licensed health care
practitioner, agency, or facility that the nurse has reasonable
cause to believe has exposed a patient to substantial risk of harm
as a result of failing to provide patient care that conforms to the:
(1) minimum standards of acceptable and prevailing
professional [nursing] practice, for a report made regarding a
practitioner; or
(2) statutory, regulatory, or accreditation
standards, for a report made regarding an agency or facility.
(f) A [registered] nurse may report to the nurse's employer
or another entity at which the nurse is authorized to practice any
situation that the nurse has reasonable cause to believe exposes a
patient to substantial risk of harm as a result of a failure to
provide patient care that conforms to minimum standards of
acceptable and prevailing professional [nursing] practice or to
statutory, regulatory, or accreditation standards. For purposes of
this subsection, the employer or entity includes an employee or
agent of the employer or entity.
SECTION 11. Section 301.403, Occupations Code, is amended
to read as follows:
Sec. 301.403. DUTY OF PEER REVIEW COMMITTEE TO REPORT. A
nursing peer review committee operating under Chapter 303 that has
a ground for reporting a nurse under Section 301.401 shall file with
the board a written, signed report that includes:
(1) the identity of the nurse;
(2) a description of any corrective action taken
against the nurse;
(3) a statement whether the nursing peer review
committee recommends that the board take formal disciplinary action
against the nurse; [and]
(4) a description of the ground for reporting;
(5) the extent to which any deficiency in care
provided by the reported nurse was the result of a factor beyond the
nurse's control rather than a deficiency in the nurse's judgment,
knowledge, training, or skill; and
(6) any additional information the board requires.
SECTION 12. Section 301.405, Occupations Code, is amended
by amending Subsections (b), (c), (d), (e), and (g), and adding
Subsection (h) to read as follows:
(b) A person that terminates, suspends for more than seven
days, or takes other substantive disciplinary action, as defined by
the board, against a nurse, or a substantially equivalent action
against a nurse who is a staffing agency nurse, because a ground
under Section 301.401 exists to report the nurse shall report in
writing to the board:
(1) the identity of the nurse;
(2) the ground that preceded the termination,
suspension, or other substantive disciplinary action or
substantially equivalent action; and
(3) any additional information the board requires.
(c) Except as provided by Subsection (g), each person
subject to this section that regularly employs, hires, or otherwise
contracts for the services of 10 or more nurses shall develop a
written plan for identifying and reporting a nurse [in its service
against whom a ground] under Section 301.401(a) [301.401 exists].
The plan must provide [include an appropriate process] for the
review of the nurse and the incident by a nursing peer review
committee established and operated under Chapter 303 [of any
incident reportable under this section and for the affected nurse
to submit rebuttal information to that committee]. Review by the
committee is only advisory, but is required, even if the nurse is
voluntarily or involuntarily terminated.
(d) The nursing [review by the] peer review committee shall
submit a report to the board that contains the information required
by Section 301.403. A report is not required under this subsection
if the nurse was terminated, either voluntarily or involuntarily,
and elected not to participate in peer review [must include a
determination as to whether a ground under Section 301.401 exists
to report the nurse undergoing review. The peer review committee's
determination must be included in the report made to the board under
Subsection (b)].
(e) The requirement under Subsection (c) that a [report to
the board be reviewed by a] nursing peer review committee review the
nurse and the incident[:
[(1) applies only to a required report; and
[(2)] does not subject a person's administrative
decision to discipline a nurse to the peer review process or prevent
a person from taking disciplinary action before review by the peer
review committee is conducted.
(g) A person is not required to develop a written plan under
Subsection (c) for peer review of[:
[(1)] a registered nurse, unless the person regularly
employs, hires, or otherwise contracts for the services of at least
five registered nurses[; or
[(2) a vocational nurse, unless the person regularly
employs, hires, or otherwise contracts for the services of at least
five vocational nurses].
(h) A plan developed under Subsection (c) must provide that
a nurse who has been terminated, either voluntarily or
involuntarily, shall have the opportunity to participate in peer
review. If the nurse elects to not participate in peer review, the
nurse waives any right to procedural due process under Section
303.002.
SECTION 13. Subsection (b), Section 301.417, Occupations
Code, is amended to read as follows:
(b) The board may disclose the information to the same
extent that the board may disclose information relating to a
complaint under Section 301.466 [use the information in connection
with an investigation or disciplinary action against a license
holder or in the subsequent trial or appeal of a board action or
order. The board may disclose the information to:
[(1) a licensing or disciplinary authority of another
jurisdiction;
[(2) a peer assistance program approved by the board
under Chapter 467, Health and Safety Code; or
[(3) a person engaged in bona fide research or another
educational purpose if all information identifying any specific
individual is first deleted].
SECTION 14. Section 301.603, Occupations Code, is amended
to read as follows:
Sec. 301.603. APPLICABILITY. Rules adopted by the board
under Section 301.602 do not apply to:
(1) an outpatient setting in which only local
anesthesia, peripheral nerve blocks, or both are used;
(2) [an outpatient setting in which only anxiolytics
and analgesics are used and only in doses that do not have the
probability of placing the patient at risk for loss of the patient's
life-preserving protective reflexes;
[(3)] a licensed hospital, including an outpatient
facility of the hospital that is located separate from the
hospital;
(3) [(4)] a licensed ambulatory surgical center;
(4) [(5)] a clinic located on land recognized as
tribal land by the federal government and maintained or operated by
a federally recognized Indian tribe or tribal organization as
listed by the United States secretary of the interior under 25
U.S.C. Section 479a-1 or as listed under a successor federal
statute or regulation;
(5) [(6)] a facility maintained or operated by a state
or local governmental entity;
(6) [(7)] a clinic directly maintained or operated by
the United States; or
(7) [(8)] an outpatient setting accredited by:
(A) the Joint Commission on Accreditation of
Healthcare Organizations relating to ambulatory surgical centers;
(B) the American Association for the
Accreditation of Ambulatory Surgery Facilities; or
(C) the Accreditation Association for Ambulatory
Health Care.
SECTION 15. Subsections (a), (b), and (c), Section 303.003,
Occupations Code, are amended to read as follows:
(a) A nursing peer review committee [that conducts a peer
review that involves only the practice of professional nursing]
must have [registered] nurses as three-fourths of its members [and
may have only registered nurses as voting members].
(b) A nursing peer review committee that conducts a peer
review that involves [only] the practice of vocational nursing
[must have registered nurses and vocational nurses as three-fourths
of its members], to the extent feasible, must include vocational
nurses as members[,] and may have only registered nurses and
vocational nurses as voting members.
(c) A nursing peer review committee that conducts a peer
review that involves the practice of [both] professional nursing
[and vocational nursing:
[(1)] must have registered nurses [and vocational
nurses] as two-thirds [four-fifths] of its members[, with
registered nurses as three-fifths of its members;
[(2) to the extent feasible must include vocational
nurses as members;] and
[(3)] may have only[:
[(A) registered nurses and vocational nurses as
voting members when a vocational nurse is being reviewed; and
[(B)] registered nurses as voting members [when a
registered nurse is being reviewed].
SECTION 16. Subsections (a), (b), (c), and (h), Section
303.005, Occupations Code, are amended to read as follows:
(a) In this section, "duty to a patient" means conduct
required by standards of practice or professional conduct adopted
by the board for [registered] nurses [or the Board of Vocational
Nurse Examiners for licensed vocational nurses]. The term includes
administrative decisions directly affecting a nurse's ability to
comply with that duty.
(b) If a person who regularly employs, hires, or otherwise
contracts for the services of at least 10 nurses requests one of
those nurses to engage in conduct that the nurse believes violates a
nurse's duty to a patient, the nurse may request, on a form
developed or approved [produced] by the board, a determination by a
nursing peer review committee under this chapter of whether the
conduct violates a nurse's duty to a patient.
(c) A nurse who in good faith requests a peer review
determination under Subsection (b):
(1) may not be disciplined or discriminated against
for making the request;
(2) may engage in the requested conduct pending the
peer review;
(3) is not subject to the reporting requirement under
Subchapter I, Chapter 301[, or the rules of the board or the Board
of Vocational Nurse Examiners]; and
(4) may not be disciplined by the board [or the Board
of Vocational Nurse Examiners] for engaging in that conduct while
the peer review is pending.
(h) A person is not required to provide a peer review
determination under this section for a request made by[:
[(1)] a registered nurse, unless the person regularly
employs, hires, or otherwise contracts for the services of at least
five registered nurses[; or
[(2) a licensed vocational nurse, unless the person
regularly employs, hires, or otherwise contracts for the services
of at least five licensed vocational nurses].
SECTION 17. Section 303.008, Occupations Code, is amended
to read as follows:
Sec. 303.008. REBUTTAL STATEMENT. (a) If a nursing peer
review committee makes an adverse finding against a nurse
[discloses information under Section 303.007(a) that could result
in the reprimand, suspension, or termination of, or other
disciplinary action against, a nurse, or itself recommends or takes
such an action], the committee shall provide the nurse with a
detailed description of [summary of information disclosed or] the
basis of its finding [action or recommendation].
(b) The peer review committee shall give the nurse the
opportunity to offer rebuttal information and to submit a rebuttal
statement of reasonable length. Any rebuttal statement must be
included with any [the] information disclosed by the committee
under Section 303.007.
SECTION 18. Section 301.005, Subsection (c), Section
301.417, and Section 304.010, Occupations Code, are repealed.
SECTION 19. Subsection (c), Section 301.155, Occupations
Code, as amended by this Act, applies only to a renewal of a license
that expires on or after the effective date of this Act. The
renewal of a license that expires before the effective date of this
Act is governed by the law that existed when the license expired,
and the former law is continued in effect for that purpose.
SECTION 20. The changes in law made by this Act regarding
reporting requirements apply only to a report made on or after the
effective date of this Act. A report made before the effective date
of this Act is governed by the law that existed when the report was
made, and the former law is continued in effect for that purpose.
SECTION 21. Sections 303.003 and 303.008, Occupations Code,
as amended by this Act, apply only to a peer review commenced on or
after the effective date of this Act. A peer review commenced
before the effective date of this Act is governed by the law that
existed when the peer review was commenced, and the former law is
continued in effect for that purpose.
SECTION 22. To the extent of any conflict, this Act prevails
over another Act of the 79th Legislature, Regular Session, 2005,
relating to nonsubstantive additions to and corrections in enacted
codes.
SECTION 23. This Act takes effect immediately if it
receives a vote of two-thirds of all the members elected to each
house, as provided by Section 39, Article III, Texas Constitution.
If this Act does not receive the vote necessary for immediate
effect, this Act takes effect September 1, 2005.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 1000 passed the Senate on
April 28, 2005, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1000 passed the House on
May 12, 2005, by the following vote: Yeas 131, Nays 0, one
present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor