TITLE 22. EXAMINING BOARDS

PART 11. TEXAS BOARD OF NURSING

CHAPTER 217. LICENSURE, PEER ASSISTANCE AND PRACTICE

22 TAC §217.2

Introduction. The Texas Board of Nursing (Board) adopts amendments to §217.2, relating to Licensure by Examination for Graduates of Nursing Education Programs Within the United States, its Territories, or Possessions without changes to the proposed text published in the March 20, 2020, issue of the Texas Register (45 TexReg 1938). The rules will not be reprinted.

Reasoned Justification. The amendments are adopted under the authority of the Occupations Code §301.2511 and §301.151. The adopted amendments require applicants to submit fingerprints for a complete criminal background check prior to licensure, in compliance with the Occupations Code §301.2511, and eliminate subsection (f) of the section because military programs, like the U.S. Army Practical Nurse Course, are reviewed and approved by the Board in the same manner as all other nursing programs. Further, military courses other than the U.S. Army Practical Nurse Course are approved by the Board.

How the Section Will Function. Adopted §217.2(a)(5) clarifies that applicants for initial licensure by examination must submit fingerprints for a complete criminal background check. Section 217.2(f) is eliminated from the section in its entirety.

Summary of Comments Received. The Board did not receive any comments on the proposal.

Statutory Authority. The amendments are adopted under the authority of the Occupations Code §301.2511 and §301.151.

Section 301.2511(a) provides that an applicant for a registered nurse license must submit to the Board, in addition to satisfying the other requirements of the subchapter, a complete and legible set of fingerprints, on a form prescribed by the Board, for the purpose of obtaining criminal history record information from the Department of Public Safety and the Federal Bureau of Investigation. Section §301.2511(b) provides that the Board may deny a license to an applicant who does not comply with the requirement of subsection (a). Issuance of a license by the Board is conditioned on the Board obtaining the applicant's criminal history record information under the section. Finally, §301.2511(c) states that the Board by rule shall develop a system for obtaining criminal history record information for a person accepted for enrollment in a nursing educational program that prepares the person for initial licensure as a registered or vocational nurse by requiring the person to submit to the Board a set of fingerprints that meets the requirements of subsection (a). The Board may develop a similar system for an applicant for enrollment in a nursing educational program. The Board may require payment of a fee by a person who is required to submit a set of fingerprints under this subsection.

Section 301.151 addresses the Board's rulemaking authority. Section 301.151 authorizes the Board to adopt and enforce rules consistent with Chapter 301 and necessary to: (i) perform its duties and conduct proceedings before the Board; (ii) regulate the practice of professional nursing and vocational nursing; (iii) establish standards of professional conduct for license holders under Chapter 301; and (iv) determine whether an act constitutes the practice of professional nursing or vocational nursing.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 4, 2020.

TRD-202001773

Jena Abel

Deputy General Counsel

Texas Board of Nursing

Effective date: May 24, 2020

Proposal publication date: March 20, 2020

For further information, please call: (512) 305-6822


22 TAC §217.3

The Texas Board of Nursing (Board) adopts amendments to §217.3, relating to Temporary Authorization to Practice/Temporary Permit, without changes to the proposed text published in the March 20, 2020, issue of the Texas Register (45 TexReg 1939). The rule will not be republished.

Reasoned Justification. The amendments are adopted under the authority of the Occupations Code §301.2511, §301.252(a), and §301.151.

First, the adopted amendments require new graduates seeking temporary authorization to practice as a graduate nurse or graduate vocational nurse to submit fingerprints for a complete criminal background check prior to licensure, in compliance with the Occupations Code §301.2511, and pass the jurisprudence exam, in compliance with the Occupations Code §301.252, prior to receiving a graduate nurse or graduate vocational nurse permit. Graduate nurses who are issued graduate permits may practice nursing if appropriately supervised. As such, the public needs to be assured that these nurses have undergone background checks to ensure safe practice and have demonstrated competency by passing the Board's jurisprudence and ethics exam.

Second, the adopted amendments make non-substantive changes to paragraph (3) to increase the readability of the paragraph.

Third, the adopted amendments clarify that a temporary permit may be re-issued if a nurse is unable to complete requirements that are necessary for the nurse's licensure reinstatement within a six-month period. Due to an individual's performance pace, it may take a nurse longer than six months to complete requirements necessary for licensure reinstatement. The intent of §217.3(c) is to provide a mechanism for nurses to demonstrate their competency to return to nursing practice. Since these nurses cannot practice nursing until they complete the Board's requirements, they pose no risk of harm to the public during this time. The adopted amendment merely allows the nurse a sufficient amount of time to re-establish current licensure after demonstrating he/she is safe and competent to do so. Further, this change is consistent with recent amendments to §217.3(b) that were adopted by the Board on January 27, 2020.

How the Sunction Will Function. Adopted §217.3(a)(1) corrects a typographical error. Adopted §217.3(a)(1)(E) requires individuals seeking temporary authorization to practice to submit fingerprints for a complete criminal background check prior to receipt of the permit. Adopted §217.3(a)(1)(F) requires individuals seeking temporary authorization to practice to obtain a passing score on the jurisprudence exam approved by the Board, effective September 1, 2009, prior to receipt of the permit. Adopted §217.3(a)(3) clarifies that a new graduate who has been authorized to practice nursing as a graduate vocational nurse pending the results of the licensing examination must work under the direct supervision of a licensed vocational nurse or a registered nurse who is physically present in the facility or practice setting and who is readily available to the graduate vocational nurse for consultation and assistance. Further, a new graduate who has been authorized to practice nursing as a graduate nurse pending the results of the licensing examination must work under the direct supervision of registered nurse who is physically present in the facility or practice setting and who is readily available to the graduate nurse for consultation and assistance. Adopted §217.3(c) clarifies that a permit may be renewed beyond six months.

Summary of Comments Received. The Board did not receive any comments on the proposal.

Statutory Authority. The amendments are adopted under the authority of the Occupations Code §301.2511, §301.252(a), and §301.151.

Section 301.2511(a) provides that an applicant for a registered nurse license must submit to the Board, in addition to satisfying the other requirements of the subchapter, a complete and legible set of fingerprints, on a form prescribed by the Board, for the purpose of obtaining criminal history record information from the Department of Public Safety and the Federal Bureau of Investigation. Section §301.2511(b) provides that the Board may deny a license to an applicant who does not comply with the requirement of subsection (a). Issuance of a license by the Board is conditioned on the Board obtaining the applicant's criminal history record information under the section. Finally, §301.2511(c) states that the Board by rule shall develop a system for obtaining criminal history record information for a person accepted for enrollment in a nursing educational program that prepares the person for initial licensure as a registered or vocational nurse by requiring the person to submit to the Board a set of fingerprints that meets the requirements of subsection (a). The Board may develop a similar system for an applicant for enrollment in a nursing educational program. The Board may require payment of a fee by a person who is required to submit a set of fingerprints under this subsection.

Section 301.252(a) provides that each applicant for a registered nurse license or a vocational nurse license must submit to the Board a sworn application that demonstrates the applicant's qualifications under this chapter, accompanied by evidence that the applicant: (1) has good professional character related to the practice of nursing; (2) has successfully completed a program of professional or vocational nursing education approved under §301.157(d); and (3) has passed the jurisprudence examination approved by the Board as provided by subsection (a-1).

Section 301.151 addresses the Board's rulemaking authority. Section 301.151 authorizes the Board to adopt and enforce rules consistent with Chapter 301 and necessary to: (i) perform its duties and conduct proceedings before the Board; (ii) regulate the practice of professional nursing and vocational nursing; (iii) establish standards of professional conduct for license holders under Chapter 301; and (iv) determine whether an act constitutes the practice of professional nursing or vocational nursing.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 4, 2020.

TRD-202001774

Jena Abel

Deputy General Counsel

Texas Board of Nursing

Effective date: May 24, 2020

Proposal publication date: March 20, 2020

For further information, please call: (512) 305-6822


22 TAC §217.6

The Texas Board of Nursing (Board) adopts amendments to 22 TAC §217.6, relating to Failure to Renew License, without changes to the proposed text published in the March 20, 2020, issue of the Texas Register (45 TexReg 1947). The rule will not be republished.

Reasoned Justification. The amendments are being adopted under the authority of the Occupations Code §301.301(d) and §301.151. Board Rule 217.6(b) addresses the licensure renewal of a nurse who is not currently practicing nursing and who has failed to maintain current licensure from any licensing authority for four or more years. The rule currently sets out the criteria that an individual must meet in order to renew his/her license under these circumstances. Among the various requirements, an individual must currently complete the online Texas Board of Nursing Jurisprudence Prep Course; the Texas Board of Nursing Jurisprudence and Ethics Workshop; or a Texas Board of Nursing approved Nursing Jurisprudence and Ethics course in addition to completing a refresher course, extensive orientation, or program of study. Fifteen percent (15%) of the required content of a Board approved refresher course, extensive orientation, or program of study must include the review of the Nursing Practice Act, Rules, Position Statements. This is the same content that is included in the online Texas Board of Nursing Jurisprudence Prep Course; the Texas Board of Nursing Jurisprudence and Ethics Workshop; and a Texas Board of Nursing approved Nursing Jurisprudence and Ethics course. The Board recognizes that the existing requirements of the rule may be unnecessarily redundant in this regard. The adopted amendments, therefore, eliminate these redundant requirements from the rule. Individuals will still be required to complete a Board approved refresher course, extensive orientation, or program of study, which must include an adequate focus on nursing jurisprudence and ethics. Further, because a nurse will still be required to successfully pass the Board's nursing jurisprudence exam, the public can be adequately assured that the nurse has successfully mastered this content prior to renewal of licensure.

How the Section Will Function. Adopted §217.6(b)(3) is eliminated from the section. The remaining amendments re-number the section accordingly.

Summary of Comments Received. The Board did not receive any comments on the proposal.

Statutory Authority. The amendments are adopted under the authority of the Occupations Code §301.301(d) and §301.151.

Section 301.301(d) provides that the Board by rule shall set a length of time beyond which an expired license may not be renewed. The Board by rule may establish additional requirements that apply to the renewal of a license that has been expired for more than one year but less than the time limit set by the Board beyond which a license may not be renewed. The person may obtain a new license by submitting to reexamination and complying with the requirements and procedures for obtaining an original license.

Section 301.151 addresses the Board's rulemaking authority. Section 301.151 authorizes the Board to adopt and enforce rules consistent with Chapter 301 and necessary to: (i) perform its duties and conduct proceedings before the Board; (ii) regulate the practice of professional nursing and vocational nursing; (iii) establish standards of professional conduct for license holders under Chapter 301; and (iv) determine whether an act constitutes the practice of professional nursing or vocational nursing.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 4, 2020.

TRD-202001776

Jena Abel

Deputy General Counsel

Texas Board of Nursing

Effective date: May 24, 2020

Proposal publication date: March 20, 2020

For further information, please call: (512) 305-6822


22 TAC §217.8

The Texas Board of Nursing (Board) adopts the repeal of 22 TAC §217.8, relating to Duplicate or Substitute Credentials, without changes to the proposed text published in the March 20, 2020, issue of the Texas Register (45 TexReg 1948). The repeal will not be republished.

Reasoned Justification. The repeal is adopted under the authority of the Occupations Code §301.151 and eliminates the section in its entirety. The Board's processes have changed over time, and the current section is now obsolete. Because an individual may now verify his/her license and print a wall certificate directly from the Board's website, the Board has stopped printing duplicate wall certificates for licensees whose original wall certificate was lost or destroyed. Additionally, the Board no longer issues wallet-sized licenses to any licensee. Further, when an individual changes his/her name and notifies the Board, the Board's online licensure verification system will reflect the name change, but the individual is not able to print a new wall certificate reflecting the name change. The wall certificate will continue to reflect the name of the individual as it was issued on the original wall certificate. As such, the current processes outlined in Board Rule 217.8 are no longer applicable.

How the Section Will Function. The adopted repeal eliminates §217.8 in its entirety.

Summary of Comments Received. The Board did not receive any comments on the proposal.

Statutory Authority. The repeal is adopted under the authority of the Occupations Code §301.151.

Section 301.151 addresses the Board's rulemaking authority. Section 301.151 authorizes the Board to adopt and enforce rules consistent with Chapter 301 and necessary to: (i) perform its duties and conduct proceedings before the Board; (ii) regulate the practice of professional nursing and vocational nursing; (iii) establish standards of professional conduct for license holders under Chapter 301; and (iv) determine whether an act constitutes the practice of professional nursing or vocational nursing.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 4, 2020.

TRD-202001777

Jena Abel

Deputy General Counsel

Texas Board of Nursing

Effective date: May 24, 2020

Proposal publication date: March 20, 2020

For further information, please call: (512) 305-6822


22 TAC §217.9

The Texas Board of Nursing (Board) adopts amendments to 22 TAC §217.9, relating to Inactive and Retired Status, without changes to the proposed text published in the March 20, 2020, issue of the Texas Register (45 TexReg 1949). The rule will not be republished.

Reasoned Justification. The amendments are adopted under the authority of the Occupations Code §301.261(d) and §301.151. Board Rule §217.9 addresses a nurse who has not practiced nursing and whose license has been in inactive status for four or more years. The rule currently sets out the criteria that an individual must meet in order to reactivate his/her license under these circumstances. Among the various requirements, an individual must currently complete the online Texas Board of Nursing Jurisprudence Prep Course; the Texas Board of Nursing Jurisprudence and Ethics Workshop; or a Texas Board of Nursing approved Nursing Jurisprudence and Ethics course in addition to completing a refresher course, extensive orientation, or program of study. Fifteen percent (15%) of the required content of a Board approved refresher course, extensive orientation, or program of study must include the review of the Nursing Practice Act, Rules, and Position Statements. This is the same content that is included in the online Texas Board of Nursing Jurisprudence Prep Course; the Texas Board of Nursing Jurisprudence and Ethics Workshop; and a Texas Board of Nursing approved Nursing Jurisprudence and Ethics course. The Board recognizes that the existing requirements of the rule may be unnecessarily redundant in this regard. The adopted amendments, therefore, eliminate these redundant requirements from the rule. Individuals will still be required to complete a Board approved refresher course, extensive orientation, or program of study, which must include an adequate focus on nursing jurisprudence and ethics. Further, because a nurse will still be required to successfully pass the Board's nursing jurisprudence exam, the public can be adequately assured that the nurse has successfully mastered this content prior to reactivation of licensure.

How the Section Will Function. The adopted amendments eliminate §217.9(g)(4) in its entirety and renumber the remaining paragraphs accordingly.

Summary of Comments Received. The Board did not receive any comments on the proposal.

Statutory Authority. The amendments are adopted under the authority of the Occupations Code §301.261(d) and §301.151.

Section 301.261(d) provides that the Board shall remove a person's license from inactive status if the person: (1) requests that the Board remove the person's license from inactive status; (2) pays each appropriate fee; and (3) meets the requirements determined by the Board.

Section 301.151 addresses the Board's rulemaking authority. Section 301.151 authorizes the Board to adopt and enforce rules consistent with Chapter 301 and necessary to: (i) perform its duties and conduct proceedings before the Board; (ii) regulate the practice of professional nursing and vocational nursing; (iii) establish standards of professional conduct for license holders under Chapter 301; and (iv) determine whether an act constitutes the practice of professional nursing or vocational nursing.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 4, 2020.

TRD-202001779

Jena Abel

Deputy General Counsel

Texas Board of Nursing

Effective date: May 24, 2020

Proposal publication date: March 20, 2020

For further information, please call: (512) 305-6822


CHAPTER 222. ADVANCED PRACTICE REGISTERED NURSES WITH PRESCRIPTIVE AUTHORITY

22 TAC §222.3

Introduction. The Texas Board of Nursing (Board) adopts amendments to §222.3, relating to Renewal of Prescriptive Authority without changes to the proposed text published in the March 20, 2020, issue of the Texas Register (45 TexReg 1951). The rules will not be republished.

Reasoned Justification. The amendments are being adopted under the authority of the Texas Occupations Code §301.151 and §157.0513, the Texas Health and Safety Code §481.0764 and §481.07635, and House Bills (HB) 2454, 2059, 3285, and 2174, enacted by the 86th Texas Legislature.

The adopted amendments are necessary for consistency with adopted changes to §216.3, pertaining to Continuing Competency. Section 216.3 was amended on November 19, 2019, in order to implement the requirements of HB 2454, HB 2059, HB 3285, and HB 2174.

Prior to its amendment in November 2019, §216.3 required advanced practice registered nurses holding prescriptive authority to complete at least three contact hours of continuing education related to prescribing controlled substances each biennium, in addition to at least five contact hours of continuing education in pharmacotherapeutics within the same licensing period. The Board originally adopted this requirement in November 2013, following the passage of SB 406, enacted by the 83rd Texas Legislature, Regular Session, effective November 1, 2013. SB 406 expanded the scope of advanced practice registered nurses by authorizing the ordering/prescribing of Schedule II controlled substances in certain settings. The additional targeted continuing education adopted by the Board at that time was reasonably related to the expanded scope of practice authorized by SB 406. Further, the requirement was also adopted during a time when the Board began seeing an increase in the number of its non-therapeutic prescribing cases related to the then up-and-coming opioid crisis.

The new continuing education requirements enacted during the 86th Legislative Session, however, were designed to provide specific education regarding many of the issues affecting the opioid crisis. The Board found many of its prior concerns to be adequately addressed by the new continuing education course requirements. Further, the Board recognized the potential overlap between the new continuing education courses and the existing education requirements for advanced practice registered nurses. As such, the Board eliminated the potentially duplicative requirements to only require advanced practice registered nurses holding prescriptive authority to complete at least five contact hours of continuing education in pharmacotherapeutics each biennium. The Board believed this change could reduce some of the financial burden associated with required continuing education courses without sacrificing the safety of the public or the competency of its practitioners.

The adopted amendments to §222.3 are now necessary to conform the section to the amendments adopted by the Board in November 2019.

How the Sections Will Function. Adopted §222.3(b) requires an advanced practice registered nurse seeking to maintain prescriptive authority to attest, on forms provided by the Board, to completing at least five contact hours of continuing education in pharmacotherapeutics within the preceding biennium. The other requirements of the subsection have been eliminated.

Summary of Comments Received. The Board did not receive any comments on the proposal.

Statutory Authority. The amendments are adopted under the Texas Occupations Code §301.151 and §157.0513, the Texas Health and Safety Code §481.0764 and §481.07635, and House Bills (HB) 2454, 2059, 3285, and 2174, enacted by the 86th Texas Legislature.

Section 301.151 authorizes the Board to adopt and enforce rules consistent with Chapter 301 and necessary to: (i) perform its duties and conduct proceedings before the Board; (ii) regulate the practice of professional nursing and vocational nursing; (iii) establish standards of professional conduct for license holders Chapter 301; and (iv) determine whether an act constitutes the practice of professional nursing or vocational nursing.

Section 157.0513(a) provides that the board, the Texas Board of Nursing, and the Texas Physician Assistant Board shall jointly develop a process to exchange information regarding the names, locations, and license numbers of each physician, APRN, and physician assistant who has entered into a prescriptive authority agreement; by which each board shall immediately notify the other boards when a license holder of the board becomes the subject of an investigation involving the delegation and supervision of prescriptive authority, as well as the final disposition of any such investigation; by which each board shall maintain and share a list of the board's license holders who have been subject to a final adverse disciplinary action for an act involving the delegation and supervision of prescriptive authority; and to ensure that each APRN or physician assistant who has entered into a prescriptive authority agreement authorizing the prescribing of opioids is required to complete not less than two hours of continuing education annually regarding safe and effective pain management related to the prescription of opioids and other controlled substances, including education regarding reasonable standards of care; the identification of drug-seeking behavior in patients; and effectively communicating with patients regarding the prescription of an opioid or other controlled substance.

Section 481.0764(f) provides that a prescriber or dispenser whose practice includes the prescription or dispensation of opioids shall annually attend at least one hour of continuing education covering best practices, alternative treatment options, and multi-modal approaches to pain management that may include physical therapy, psychotherapy, and other treatments. The board shall adopt rules to establish the content of continuing education described by this subsection. The board may collaborate with private and public institutions of higher education and hospitals in establishing the content of the continuing education. This subsection expires August 31, 2023.

Section 481.07635(a) provides that a person authorized to receive information under Section 481.076(a)(5) shall, not later than the first anniversary after the person is issued a license, certification, or registration to prescribe or dispense controlled substances under this chapter, complete two hours of professional education related to approved procedures of prescribing and monitoring controlled substances.

Section 481.07635(b) states that a person authorized to receive information may annually take the professional education course under this section to fulfil hours toward the ethics education requirement of the person's license, certification, or registration.

Section 481.07635(c) states that the regulatory agency that issued the license, certification, or registration to a person authorized to receive information under Section 481.076(a)(5) shall approve professional education to satisfy the requirements of this section.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on May 4, 2020.

TRD-202001772

Jena Abel

Deputy General Counsel

Texas Board of Nursing

Effective date: May 24, 2020

Proposal publication date: March 20, 2020

For further information, please call: (512) 305-6822