By: McReynolds 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 of and including the
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-.409 or to specific rules governing the practice,
education or reporting of registered nurses adopted under this
chapter or Chapter 303. 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) If the board grants an exception to the mandatory
reporting requirements of Sections 301.401-.409 or to the specific
rules governing the practice, education or reporting of registered
nurses adopted under this chapter or Chapter 303, 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. Section 301.303, Occupations Code, is amended to
read as follows:
Sec. 301.303. CONTINUING COMPETENCY [EDUCATION]. (a) The
board may recognize, prepare, or implement a continuing competency
program [education programs] for license holders under this chapter
and may require participation in the program [continuing education
programs] as a condition of renewal of a license. The board may
allow a license holder to demonstrate continued competency through
various mechanisms including targeted continuing education,
certification, and professional portfolio.
(b) The board may not require participation in more than a
total of 20 hours of continuing education in a two-year licensing
period and may not require that more than 10 hours of the continuing
education consist of classroom instruction in approved programs.
The remaining hours of continuing education may consist of any
combination of:
(1) classroom instruction;
(2) institutional-based instruction; or
(3) individualized study.
(c) If the board requires participation in continuing
education programs as a condition of license renewal, the board by
rule shall establish a system for the approval of programs and
providers of continuing education.
(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.
(e) The board may adopt [other] rules as necessary to
implement this section.
(f) The board may assess each program and provider under
this section a fee in an amount that is reasonable and necessary to
defray the costs incurred in approving programs and providers.
SECTION 4. 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.
(c) The board may adopt rules establishing specifications
for the insignia.
SECTION 5. 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, that is not required to be reported
pursuant to rules adopted by the board under Section 301.419.
SECTION 6. 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,
an entity at which the nurse is authorized to practice, or an
appropriate agent of such employer or entity 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 any employee or agent
of that employer or entity.
SECTION 7. 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 8. 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 9. 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 10. 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 11. 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 12. Subchapter B, Chapter 241, Health and Safety
Code, is amended by adding Section 241.0264 to read as follows:
Sec. 241.0264. POLICIES RELATING TO WORKPLACE SAFETY (a)
Hospitals shall adopt policies and procedures relating to the work
environment for nurses to:
(1) improve workplace safety to reduce risk of
violence, injury and occupational illness; and
(2) improve the use of ergonomic principles and
ergonomically designed devices to reduce injury and fatigue.
(b) In developing policies, hospital shall address:
(1) evaluating new products and technology
incorporating ergonomic principles;
(2) controlling access to areas with high risk of
violence;
(3) educating staff in application of ergonomic
practices;
(4) conducting workplace audits to identify areas of
risks and recommended ways to reduce risks; and
(5) reporting of crimes against hospital personnel to
appropriate law enforcement agencies.
SECTION 13. 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.