78R7417 MXM-F
By: McReynolds H.B. No. 2324
Substitute the following for H.B. No. 2324:
By: Naishtat C.S.H.B. No. 2324
A BILL TO BE ENTITLED
AN ACT
relating to the practice and regulatory environment for registered
nurses and licensed vocational nurses.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter D, Chapter 301, Occupations Code, is
amended by adding Sections 301.1605 and 301.1606 to read as
follows:
Sec. 301.1605. PILOT PROGRAMS FOR INNOVATIVE APPLICATIONS.
(a) The board may approve and adopt rules regarding pilot programs
for innovative applications in the practice and regulation of
professional nursing.
(b) The board shall specify the procedures to be followed in
applying for approval of a pilot program. The board may condition
approval of a program on compliance with this section and rules
adopted under this section.
(c) In approving a pilot program, the board may grant the
program an exception to the mandatory reporting requirements of
Sections 301.401-301.409 or to a rule adopted under this chapter or
Chapter 303 that relates to the practice of professional nursing,
including education and reporting requirements for registered
nurses. The board may not grant an exception to the mandatory
reporting requirements unless the program:
(1) is designed to evaluate the efficiency of
alternative reporting methods; and
(2) provides consumers adequate protection from
registered nurses whose continued practice is a threat to public
safety.
Sec. 301.1606. PILOT PROGRAMS ON NURSE REPORTING SYSTEMS.
(a) Before January 1, 2004, the board shall solicit proposals for
pilot programs designed to evaluate the efficacy and effect on
protection of the public of reporting systems designed to encourage
identification of system errors.
(b) The board may grant a pilot program approved under this
section an exception to the mandatory reporting requirements of
Sections 301.401-301.409 or to a rule adopted under this chapter or
Chapter 303 that relates to the practice of professional nursing,
including education and reporting requirements for registered
nurses. If the board grants an exception, the board may require
that the program:
(1) provide for the remediation of the deficiencies of
a registered nurse who has knowledge or skill deficiencies that
unless corrected may result in an unreasonable risk to public
safety;
(2) provide for supervision of the nurse during
remediation of deficiencies under Subdivision (1);
(3) require reporting to the board of a registered
nurse:
(A) who fails to satisfactorily complete
remediation, or who does not make satisfactory progress in
remediation, under Subdivision (1);
(B) whose incompetence in the practice of
professional nursing would pose a continued risk of harm to the
public; or
(C) whose error contributed to a patient death or
serious patient injury; or
(4) provide for a nursing peer review committee to
review whether a registered nurse is appropriate for remediation
under Subdivision (1).
(c) The board may require that the entity conducting a pilot
program under this section reimburse the board for the cost of
monitoring and evaluating the pilot program.
(d) The board may contract with a third party to perform the
monitoring and evaluation.
(e) The board may limit the number of pilot programs that it
approves under this section.
SECTION 2. Section 301.251, Occupations Code, is amended by
adding Subsection (d) to read as follows:
(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 3. The heading to Section 301.303, Occupations
Code, is amended to read as follows:
Sec. 301.303. CONTINUING COMPETENCY [EDUCATION].
SECTION 4. Sections 301.303(a) and (d), Occupations Code,
are amended to read as follows:
(a) The board may recognize, prepare, or implement
continuing competency [education] programs for license holders
under this chapter and may require participation in continuing
competency [education] programs as a condition of renewal of a
license. The programs may allow a license holder to demonstrate
competency through various methods, including:
(1) completion of targeted continuing education
programs; and
(2) consideration of a license holder's professional
portfolio, including certifications held by the license holder.
(d) In adopting rules under Subsection (c), the board shall
consider, but is not obligated to approve:
(1) a program or provider approved or accredited
through the [Board of Accreditation of the] American Nurses
[Nurses'] Association Credentialing Center [or the National
Federation of Specialty Nursing Organizations]; and
(2) a nurse in-service program offered by a hospital
that is:
(A) accredited by the Joint Commission on
Accreditation of Healthcare Organizations;
(B) certified by Medicare; or
(C) maintained or operated by the federal
government or the state.
SECTION 5. Section 301.351, Occupations Code, is amended by
amending Subsection (b) and adding Subsection (c) to read as
follows:
(b) While interacting with the public in a professional
nursing role [on duty providing direct care to a patient], each
licensed registered nurse shall wear a clearly legible [an]
insignia identifying the nurse as a registered nurse. The insignia
may not contain information other than:
(1) the registered nurse designation;
(2) the nurse's name, certifications, academic
degrees, or practice position; and
(3) the name of the employing facility or agency, or
other employer.
(c) The board may adopt rules establishing specifications
for the insignia.
SECTION 6. Section 301.401, Occupations Code, is amended to
read as follows:
Sec. 301.401. GROUNDS FOR REPORTING REGISTERED NURSE. (a)
Except as provided by Subsection (b), the [The] following are
grounds for reporting a registered nurse under Section 301.402,
301.403, 301.405, or 301.407:
(1) unnecessary or likely exposure by the registered
nurse of a patient or other person to a risk of harm;
(2) unprofessional conduct by the registered nurse;
(3) failure by the registered nurse to adequately care
for a patient;
(4) failure by the registered nurse to conform to the
minimum standards of acceptable professional nursing practice; or
(5) impairment or likely impairment of the registered
nurse's practice by chemical dependency.
(b) Subsection (a) does not apply to a minor incident, as
defined by Section 301.419, if the incident is not required to be
reported under a rule adopted under Section 301.419.
SECTION 7. Section 301.402, Occupations Code, is amended by
adding Subsection (f) to read as follows:
(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. For
purposes of this subsection, the employer or entity includes an
employee or agent of the employer or entity.
SECTION 8. Subchapter J, Chapter 301, Occupations Code, is
amended by adding Section 301.4515 to read as follows:
Sec. 301.4515. USE OF CERTAIN NURSING TITLES. Unless the
person is practicing under the delegated authority of a registered
nurse or is otherwise authorized by state or federal law, a person
may not use, in connection with the person's name:
(1) the title "nurse aide," "nurse assistant," or
"nurse technician"; or
(2) any other similar title.
SECTION 9. Section 301.457, Occupations Code, is amended by
adding Subsection (f) to read as follows:
(f) In making a determination under Subsection (e), the
board shall review the evidence to determine the extent to which a
deficiency in care by the registered nurse was the result of
deficiencies in the registered nurse's judgment, knowledge,
training, or skill rather than other factors beyond the nurse's
control. A determination that a deficiency in care is attributable
to a registered nurse must be based on the extent to which the
registered nurse's conduct was the result of a deficiency in the
registered nurse's judgment, knowledge, training, or skill.
SECTION 10. Sections 303.005(a), (b), (c), (d), and (f),
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 [registered] 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 [registered] nurses
requests one of those nurses to engage in conduct that the nurse
believes violates a [registered] nurse's duty to a patient, the
nurse may request, on a form produced by the board, a determination
by a nursing peer review committee under this chapter of whether the
conduct violates a [registered] nurse's duty to a patient.
(c) A [registered] 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.
(d) The determinations of the peer review committee shall be
considered in a decision to discipline the nurse, but the
determinations are not binding if a [registered] nurse
administrator believes in good faith that the peer review committee
has incorrectly determined a [registered] nurse's duty.
(f) A [registered] nurse's rights under this section may not
be nullified by a contract.
SECTION 11. Section 303.006, Occupations Code, is amended
by adding Subsection (f) to read as follows:
(f) If a peer review committee determines that a nurse has
not engaged in conduct required to be reported to the nurse's
licensing board, a member of the peer review committee whose
knowledge of the nurse's conduct was acquired only through the peer
review may not report that nurse to the licensing board for that
conduct. A committee member is not prohibited from reporting:
(1) the nurse, if the member has knowledge of the
nurse's conduct independently of peer review; or
(2) the peer review committee to the licensing board,
if the member believes the committee made its determination in bad
faith.
SECTION 12. Chapter 303, Occupations Code, is amended by
adding Section 303.011 to read as follows:
Sec. 303.011. EVALUATION BY COMMITTEE. In evaluating a
nurse's conduct, the nursing peer review committee shall review the
evidence to determine the extent to which a deficiency in care by
the nurse was the result of deficiencies in the nurse's judgment,
knowledge, training, or skill rather than other factors beyond the
nurse's control. A determination that a deficiency in care is
attributable to a nurse must be based on the extent to which the
nurse's conduct was the result of a deficiency in the nurse's
judgment, knowledge, training, or skill.
SECTION 13. Subchapter B, Chapter 241, Health and Safety
Code, is amended by adding Section 241.029 to read as follows:
Sec. 241.029. POLICIES AND PROCEDURES RELATING TO WORKPLACE
SAFETY. (a) The governing body of a hospital shall adopt policies
and procedures related to the work environment for nurses to:
(1) improve workplace safety and reduce the risk of
injury, occupational illness, and violence; and
(2) increase the use of ergonomic principles and
ergonomically designed devices to reduce injury and fatigue.
(b) The policies and procedures adopted under Subsection
(a), at a minimum, must include:
(1) evaluating new products and technology that
incorporate ergonomic principles;
(2) educating nurses in the application of ergonomic
practices;
(3) conducting workplace audits to identify areas of
risk of injury, occupational illness, or violence and recommending
ways to reduce those risks;
(4) controlling access to those areas identified as
having a high risk of violence; and
(5) promptly reporting crimes committed against
nurses to appropriate law enforcement agencies.
SECTION 14. A hospital must adopt policies and procedures
required by Section 241.029, Health and Safety Code, as added by
this Act, not later than January 1, 2004.
SECTION 15. 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, 2003.