Texas Board Of Nursing Bulletin Volume 44, No. 3 Texas .

July 2013Texas Board of Nursing BulletinVolume 44, No. 3Summary of ActionsA regular meeting of the Board of Nursing was held April 18-19, 2013, in Austin.The following is a summary of Board actions taken during this meeting.On May 17, 2013, the Board proposedamendments to 22 Tex. Admin. Code(TAC) sections 211.4 (relating to Officers),213.27 (relating to Good ProfessionalCharacter), 213.28 (relating to Licensureof Persons with Criminal Offenses),213.29 (relating to Criteria and ProcedureRegarding Intemperate Use and Lack ofFitness in Eligibility and DisciplinaryMatters), 213.30 (relating to DeclaratoryOrder of Eligibility for Licensure), 213.33(relating to Factors Considered forImposition of Penalties/Sanctions), and217.14 (relating to Registered NursesPerforming Radiologic Procedures). Thecomment period ended on June 17,2013. No comments were received.The amendments to 22 TAC 211.4specifies that the term of the VicePresident will be a two-year term andthat Board elections will be held biennially, based upon the calendar year.The amendments to 22 TAC 217.14 updateoutdated references in the rule and correctgrammatical/typographical errors.The amendments to 213.27 - 213.30 and213.33 affect the Board’s DisciplinaryGuidelines for Criminal Conduct. The Boardissued a charge to the Eligibility andDisciplinary Advisory Committee to reviewand make recommendations regarding theGuidelines. The Committee’s recommended changes to the Guidelines, alongwith minor editorial/typographical changesidentified by Board Staff, were presented tothe Board at its April 2013 meeting. TheBoard voted to adopt the Guidelines, asamended.While many of the changes to theGuidelines are editorial and organizationalin nature, some of the changes are moresubstantive. First, thirty-five new criminaloffenses have been added to the Guide-lines. These offenses include variousfelonies and misdemeanors, as well ascrimes that have been specificallyidentified by the Texas Legislature in theOccupations Code §301.4535 as affecting nursing licensure. In addition toincluding these additional crimes in theGuidelines, corresponding sanction recommendations and explanatory rationale has been included as well. TheGuidelines also explain how each of theadditional offenses are related to thepractice of nursing. Finally, the Guidelines indicate when a particular evaluation may be required and/or requestedby the Board.Amended 22 TAC 211.4, 217.14. 213.27 213.30 will become effective July 10,2013 and 213.33 will become effectiveon July 11, 2013.Nursing Education Actions - April 2013 Board MeetingReviewed Reports on:Status of Inquiries, Proposals, andApproval Status of New NursingEducation Programs; Status ofPrograms with Sanctions;Communication Activities withNursing Education Programs; and2012 NCLEX-PN Examination PassRates.Approved Reports of Regular Survey Visits:Angelina College Associate DegreeNursing Education Program in Lufkin;Angelina College Vocational NursingEducation Program in Lufkin;Laredo Community College VocationalNursing Education Program inLaredo; andTexarkana College Vocational NursingEducation Program in Texarkana.*Approved addendum request to aninnovative pilot project:Collin County Community CollegeAssociate Degree Nursing EducationProgram in McKinney, TexasProject Among a Group of AssociateDegree Nursing Education Programsfor An Innovative ProfessionalNursing Education Program ApproachUsing Concept-Based Instruction.*Changed Program Approval Status fromInitial to Full Approval:Fortis Institute Vocational NursingEducation Program in Grand Prairie;Teamwork Services Vocational NursingEducation Program in Grand Prairie; andThe College of Health Care ProfessionsVocational Nursing EducationProgram in Houston.*Changed Program Approval Status fromFull with Warning to Full Approval:*Granted Initial Approval to Establish aNew Associate Degree Nursing EducationProgram:Cisco College in Abilene; andConcorde Career College in Dallas.*Granted Initial Approval to Establish aNew Family Nurse Practitioner Program:Texas State University St. David’s Schoolof Nursing in Round Rock*Withdrew program approval:Clarendon College VocationalNursing Education Program inPampa; andValley Grande Institute Vocational NursingEducation Program in Weslaco.Midland College Vocational NursingEducation Program in Midland*Changed Program Approval Status fromFull with Warning to Conditional:Midland College Vocational NursingEducation Program in Fort StocktonPlatt College Vocational NursingEducation Program in Dallas; andUniversal Health Services School ofVocational Education – VocationalNursing Education Program inFort Worth.*Approved report of follow-up surveyvisit:*Granted Initial Approval to Establish aNew Baccalaureate Degree Nursing Education Program:*Approved a policy regarding timeline fornewly approved programs to beginUniversity of Texas of the Permian Basinin Odessa3*Approved request to establish anextension site/campus:Wayland Baptist UniversityBaccalaureate Degree NursingEducation Program in San Antonio

July 2013Texas Board of Nursing BulletinVolume 44, No. 3Academic Progression in Nursing:A Response to the Future of NursingBy Helen Reid, EdD, RN, CNE, Provost, Trinity Valley Community College; Susy Sportsman, RN, PhD, ANEF, FAAN,Director, Academic Consulting Group: A Service of Elsevier; and Kathryn Tart, EdD, RN, Founding Dean andProfessor, University of Houston – Victoria School of Nursing.Nursing leaders, regulators and legislators are becoming increasingly concerned about the barriers to academicprogression in Texas. Texas was one ofnine states privileged to receive theAcademic Progression in Nursing (APIN)grant from the Robert Wood JohnsonFoundation through the Tri-Council.The APIN project aims to address thechallenges of academic progression tocreate a more educated and diverseTexas nursing workforce, important tomeet current and future health careneeds.The Texas Nurses Foundation, TexasAction Coalition, and project directors,Dr. Kathryn Tart, from the University ofHouston – Victoria, Dr. Susy Sportsman, and Dr. Helen Reid, from TrinityValley Community College, are implementing a multi-focused statewideplan with the ultimate goal of assistingRN to BSN programs to increase by230% the number of associate degreeprepared nurses graduating each year,from 1,826 in AY 2010-2011 to 4,200 inAY2013-2014.Education, practice and diversity formthe cornerstones of the project. It willtake many different strategies to meetthe Institute of Medicine (IOM) recommendation of 80% of RNs with BSNs by2020. One strategy is the creation ofthe Consortium for Advancing Baccalaureate Nursing Education in Texas(CABNET), a unique partnership between universities and communitycolleges. APIN’s strategies focus on thecommunity college student who wantsto be a nurse. These students will beencouraged to take the general education courses for both the ADN and RN-to-BSN levels so that when theycomplete the general educationcourses, the two-year ADN programand pass NCLEX-RN , they will need tocomplete only the last year of upperdivision BSN nursing courses. TheCABNET pathway standardizes thegeneral education courses for a 120semester credit hour ADN-BSN degree.This 1 2 1 pathway will result in ahigher percentage of ADN graduatescontinuing their nursing education andincreasing their employability.Several RN-to-BSN and MSN faculty aredeveloping concept-based courses thatwill complement the ADN level concept-based curriculum being implemented in the fall of 2013. Throughsurveys and focus groups, practicepartners will contribute what qualitiesthe “Nurse of the Future” shouldpossess. To assist with faculty development on this new approach to nursingeducation, the APIN grant is hostingfour webinars led by national leaders toteach nursing faculty about teaching ina concept-based curriculum.Thearchived webinars can be found on theAPIN website at www.texasapin.org.Dr. Josefina Lujan, from the Texas TechUniversity Health Sciences Center GayleGreve Hunt School of Nursing in ElPaso, is leading a mentorship programthat assists RNs representing ethnicand gender diversity to obtain theirBSN. To date, Diversity Championsfrom all eight Team Texas regions arerecruiting mentors, and many regionshave secured their students to mentor.Dr. Terry Kirk, from the University ofHouston – Victoria, serving in dual rolesas a member of the diversity advisory4committee and Diversity Champion hasplans for starting a chapter of the Menin Nursing Association in the greaterHouston area. Champions plan to holdinformation sessions at Hispanic serving community colleges and localminority nursing associations to encourage current ADN graduates toreturn for their BSN.Information regarding the APIN grant,its practice partners, diversity, curriculum and CABNET agreements can befound at www.texasapin.org. Weinvite you to visit the website and learnmore about this exciting activity forTexas nurses.Did You know.The Board of Nursing (BON) hasinformation on Continuing NursingEducation (CNE) on the website inNursing Education then ContinuingCompetency Requirements forNurses. This includes the CNErequirements and what certificationscan be used to meet continuingcompetency requirements. When youaccess the Continuing CompetencyFrequently Asked Questions you canlearn more about area of practice,the audit process, and theresponsibilities you have as a nursein relation to continuing competency.There is even an easy to access linkto the Continuing Competency rulesin Chapter 216 of the TexasAdministrative Code.

July 2013Texas Board of Nursing BulletinVolume 44, No. 3FREQUENTLY ASKED QUESTIONS - RN Delegation in the Independent Living EnvironmentQuestion: I recently learned that the list oftasks that a RN may designate as healthmaintenance activities (HMAs) has beenexpanded. Is that true? Topically applied medications Insulin administrationsubcutaneously, nasally, or via aninsulin pumpAnswer: Yes, the Boardapproved expanding thislist during the January2013 meeting, accordingto their authority underRule 225.4(8) (E).Because all nurses arerequired to promote asafe environment fortheir clients and others[BoardRule217.11(1)(B)], the RNmust always considerwhat is safest for theclient when makingdecisions to designate a task a HMA thatdoes not require delegation.Nursesare reminded to document their decisionsconcerning delegation in the client’s record.RNs in independent living environments suchas home and community-based settings orschool health must utilize the rules inChapter 225, RN Delegation to UnlicensedPersonnel and Tasks Not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions, when making decisionsthat pertain to delegation. The RN,depending on the assessment of the clientand the delegation criteria, may decide to:designate a task a HMA that does notrequire delegation; delegate a task to anunlicensed person; or have a nurse performthe task.HMAs are defined as “tasks that enable theclient to remain in an independent livingenvironment and that go beyond activitiesof daily living (ADLs) because of the higherskill level required to perform”, [Board Rule225.4(8)]. The Board believes that expanding the list of HMAs will foster a client’sindependence and further supports a clientor the client’s responsible adult (CRA) whois able to train and supervise unlicensedpersonnel in the performance of a HMA,thus enabling the client to remain in theleast restrictive environment possible. Fora complete list of tasks that can bedesignated as HMAs please refer to BoardRule 225.4(8) (A-E). The additional tasksthat may be designated as HMAs are: Noninvasive ventilation (NIV) suchas continuous positive airwaypressure (CPAP) and bi-levelpositive airway pressure (BiPAP)therapy Routine administration of aprescribed dose of oxygen Unit dose medicationadministration by way ofinhalation (MDIs) includingmedications administered asnebulizer treatments forprophylaxis and/or maintenanceQuestion: Are there anymedications or procedures thatmay be delegated in an emergencysituation in independent livingenvironments such as in homehealth or school health?Answer: In January 2013, theBoard approved a list of lifesustaining medications andtreatments that a RN maydelegate in emergency situationsfor clients residing in independentliving environments, provided theRN has an order to administer orperform the treatment and the client hasreceived a diagnosis that required aprescription for: Glucagon injections for treatmentof severe hypoglycemia inunconscious clients or clients whoare unable to swallow oral glucose Epinephrine injections from asingle-dose pre-filled automaticinjection device for severe allergicanaphylactic reactions Diazepam rectal gel in a pre-filledsyringe for episodes of increasedseizure activity Nitroglycerin tablet(s) administeredsublingually for the acute relief ofan attack of angina pectoris Use of a hand held magnet toactivate a vagus nerve stimulatorto prevent or control seizureactivity Metered dose inhalers or nebulizertreatments for the relief of acuterespiratory symptoms5 Oxygen administration for the relief ofacute respiratory symptomsPlanning for emergencies in independentliving environments requires the RN toutilize both Chapter 224, Delegation ofNursing Tasks by Registered ProfessionalNurses to Unlicensed Personnel for Clientswith Acute Conditions or in Acute CareEnvironments, and Chapter 225. RNs mustuse their nursing judgment to decide whenit is safe and appropriate to delegate lifesustaining medications and treatments tounlicensed personnel in independent livingenvironments such as community-basedsettings, client homes or schools.While all the delegation criteria areimportant in Board Rule224.6, the RN must takeinto consideration howthe supervisory standardswill be met as delegationdecisions are made. TheRN is required to provideadequate supervisionwhile an unlicensed personis performing a task,particularly in emergencysituations. The RN mustconsider his or hergeographical distance andthe time it takes to reach aclient that is experiencingan emergency in order to direct unlicensedpersonnel when to notify the EmergencyMedical System (EMS). RNs are alsoresponsible for timely follow-up, whichmay include a face-to-face assessmentdepending on the emergency situation andthe RN’s location to the individual.Delegation decisions and instructions tounlicensed personnel should bedocumented in the client’s record.For more information about delegation,visit the Nursing Practice and AdvancedPractice section of the BON website atwww.bon.texas.gov/practice/.Did You know.NCSBNLaunches Mobile SiteThe National Council of State Boards ofNursing Inc. launched its new mobilewebsite, m.ncsbn.org, to optimize theexperience of smartphone and tablet users.The new website features the most popularcontent from the site, including NCLEXExams, Nurse Licensure Compact, nurselicense verification and board of nursingcontact details.

July 2013Texas Board of Nursing BulletinVolume 44, No. 3TPAPN Advocates: Assisting Nurses in their Darkest – and Brightest HoursBy Mike Van Doren, MSN, RN, CARN,Program Director and Ginger Coburn,LCDC, Case Manager. . . sometimes our ordinary labor, administered in the right dose at the right time,can provide extraordinary mercy. And inour world, our colleagues never have tofear facing their darkest hours alone.1The Texas Peer Assistance Program forNurses (TPAPN) is a private, nonprofitprogram of the Texas Nurses Foundationthat provides approved peer assistanceservices for the Texas Board of Nursing(BON). TPAPN’s mission is to offer nurseslife-renewing opportunities for recoveryfrom substance use disorders and certainpsychiatric disorders, and to protect thepublic by promoting professional accountability and returning nurses to safe practice.Referrals may be made directly to TPAPN;however, if a practice violation is suspected, the report must be made to theBON.Volunteer advocates for TPAPN provideencouragement and support to participating nurses that are working hard to recover.The following excerpt from an emailexchange between a participant and herTPAPN Case Manager attests to thepresence and insight created by anadvocate.Dear Ginger, When I discovered I couldn’twork, my alcoholic mind went straight tothe worst case scenario.i.e. there wouldbe no presents under the tree for mychildren; I would lose my job; I wouldn’t beable to make my house payment and wouldhave to move back in with my family . Myadvocate gave me hope .Sometimes it may seem that those whocare the most for others receive the leastamount of care from their colleagues.However, TPAPN is one avenue for nursesto change that value system. There areTPAPN advocates who have successfullycompleted the TPAPN program and continue to maintain their recovery. Approximately 50% of all advocates simply have adesire to help nurses going through TPAPN.Advocates are motivated to volunteer forpersonal reasons that stem from pastfamily issues or prior experiences withcolleagues, i.e., “the work family.” Thedesire to advocate may also arise fromone’s spiritual center that is fulfilledthrough giving to others. In the process ofgiving to others, advocates learn first-handfrom participants about TPAPN and recov-ery from substance use disorders andcertain psychiatric disorders. In the finalanalysis however, almost every TPAPNadvocate will tell you that having theopportunity to witness an individual’srecovery is sufficient reward.On November 8 and 9, 2013, in Austin,TPAPN will be providing a free advocatetraining for nurses whose advocate applications have been approved for attendance. Other interested persons mayregister and pay a fee to attend. MarieManthey, RAAN, MNA, RFCN, PhD (hon.),will be the featured guest speaker andnursing contact hours will be awarded. It isimportant to note that nurses interested inbecoming TPAPN advocates do not have tobe graduates of the program. If thepotential TPAPN advocate is a graduate ofthe TPAPN program, then TPAPN requiresat least two years of good recovery or solidsobriety to be eligible. To obtain anddownload the TPAPN advocate applicationgo to: www.tpapn.org and click on the“volunteer” link or call TPAPN at 512-4677027 ext. 105 to obtain more information.Come join the over 200 active nurseadvocates with TPAPN and somedayanother nurse may thank you.1Simko S. A doctor’s ordinary labor canprovide extraordinary mercy. In TexasChildren’s Blog. 2012. Available inary-labor-can-provide-extraordinary-mercy/. Accessed September28, 2012.What Nurses are ReadingDuring the last month, the most popular articles that nurses were reading,according to Medscape, included thefollowing: How to Prevent C difficileInfection: A New Guide (fromMedscape Infectious Diseases)Nurses Critical to ImplementingNew Sepsis Guidelines (fromMedscape Medical News)Probiotics Affect Brain Activity(from Medscape Medical News)Guidelines for Using Electronicand Social Media (from The OnlineJournal of Issues in Nursing)Bedside Shift Report Works forPatients, Staff (from MedscapeMedical News)Virtual Visiting (from AmericanNurse Today)Extended Use of MagnesiumSulfate Can Harm Fetus, FDA Says(from News Alerts)ACP Releases New Guidelines forIn-Hospital Hyperglycemia (fromMedscape Medical News)Is Experience Overrated? (fromNursing Economics)A Guide to DSM-5 (fromMedscape Psychiatry)6These articles may be accessed atwww.medscape.comIn the April Texas Board of NursingBulletin, we asked you what youwere reading and you reported thefollowing:1.Gawande, A. (2009). Thechecklist manifesto, how to getit right. New York: MetropolitanBooks.2. Crowther, A. (2009). Nursemanagers: A guide to practice.Ausmed Publications.3. Brawley, O., and Goldberg, P.(2011). How we do harm, adoctor breaks ranks about beingsick in America. New York: St.Martin’s Press.Many thanks to all of you whocontributed to this section of theBON Bulletin. Please let us knowwhat you are reading. We wouldlike to hear from you. Go to:https://www.surveymonkey.com/s/3L6JKWB. Insert you favoritejournal article, report or book andsee it listed in the next quarterlyBulletin.

July 2013Texas Board of Nursing BulletinVolume 44, No. 3Texas Board of Nursing Continuing N

Executive Director Katherine Thomas, MN, RN, FAAN The Texas Board of Nursing Bulletin is the official publication of the Texas Board of Nursing and is published four times a year: January, April, July, and October. Subscrip-tion price for residents within the continental U.S. is 15.00, plus tax. Published by: TEXAS