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A BILL TO BE ENTITLED
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AN ACT
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relating to the practice of nursing; providing civil penalties. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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ARTICLE 1. HOSPITAL PATIENT PROTECTION ACT |
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SECTION 1.01. Chapter 241, Health and Safety Code, is |
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amended by adding Subchapter I to read as follows: |
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SUBCHAPTER I. HOSPITAL PATIENT PROTECTION |
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Sec. 241.251. SHORT TITLE. This subchapter may be cited as |
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the Hospital Patient Protection Act. |
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Sec. 241.252. DEFINITIONS. In this subchapter: |
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(1) "Direct care registered nurse" means a nurse |
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described by Section 301.651, Occupations Code. |
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(2) "Nurse" has the meaning assigned by Section |
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301.002, Occupations Code. |
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Sec. 241.253. HOSPITAL NURSING SERVICE REQUIRED. Each |
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hospital shall maintain an organized nursing service. The hospital |
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shall ensure that the nursing service: |
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(1) is available 24 hours each day; |
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(2) is adequately organized, equipped, and staffed to |
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meet the needs of the hospital's patients; and |
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(3) meets the requirements of this subchapter and |
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rules adopted by the department. |
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Sec. 241.254. ORGANIZATION OF NURSING SERVICE. (a) Each |
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hospital's nursing service must be under the direction of a chief |
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nursing officer. To qualify as chief nursing officer a person must |
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be currently licensed to practice professional nursing under |
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Chapter 301, Occupations Code, and must meet the requirements under |
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rules adopted by the department and the Texas Board of Nursing. |
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(b) The chief nursing officer shall report directly to the |
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senior manager of the hospital. |
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(c) A hospital's governing board shall adopt the following |
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written policies: |
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(1) an unconditional assurance that the chief nursing |
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officer has authority over the hospital's nursing service and is |
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responsible and accountable for the operation of the nursing |
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service; |
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(2) a complete description of the structure of the |
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hospital nursing service, including any committees or nursing |
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service units, and a designation of the person accountable for the |
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operation of each part of the nursing service; |
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(3) a clear definition of the relationship between the |
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hospital nursing service, hospital administration, hospital |
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departments, and medical staff; and |
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(4) a requirement that a committee in the hospital may |
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not consider an issue affecting nursing care unless the committee |
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includes at least one direct care registered nurse as a full |
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participating and voting member. |
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Sec. 241.255. COMPETENCY. A hospital may not assign a |
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nurse or unlicensed nursing staff member to a nursing unit or |
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clinical area unless: |
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(1) the hospital and the nurse or staff member |
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determine under written guidelines developed by the hospital that |
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the nurse or staff member is currently competent to provide care in |
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the unit or area; and |
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(2) the nurse or staff member has received training |
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with regard to the unit or area sufficient to allow the nurse or |
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staff member to provide safe, therapeutic, and competent care to |
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the patients in the unit or area. |
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Sec. 241.256. NURSE STAFFING. (a) Each hospital shall |
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have on duty at all times: |
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(1) a sufficient number of direct care registered |
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nurses to meet the requirements of this section; and |
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(2) any additional nurses and unlicensed nursing staff |
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members required under the hospital's patient classification |
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system. |
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(b) The chief nursing officer for a hospital or a person |
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designated by the chief nursing officer shall develop a written |
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nurse staffing plan for each shift in each patient care unit in the |
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hospital, based on the validated output of the hospital's patient |
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classification system. The plan shall specify the number of direct |
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care registered nurses, other nurses, and unlicensed nursing staff |
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members required to meet the needs of the patients in each patient |
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care unit. |
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(c) Each hospital's nurse staffing plan must anticipate |
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fluctuations in the number of patients in each patient care unit |
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from routine causes, including admissions, discharges, and |
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transfers. If an emergency declared by a federal, state, or local |
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government causes a sudden change in the number of patients in a |
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patient care unit, the hospital shall make an immediate and |
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diligent effort to maintain the staffing levels required by this |
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section and shall document that effort. |
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(d) The hospital may not designate the chief nursing officer |
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as a charge nurse or as a direct care registered nurse in the nurse |
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staffing plan. |
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(e) Each hospital shall develop a process by which any staff |
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member can provide feedback and make a recommendation regarding the |
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nurse staffing plan. |
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(f) A hospital may use an unlicensed nursing staff member to |
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assist with simple nursing procedures. Each unlicensed nursing |
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staff member must meet the competency requirements under Section |
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241.255. The hospital shall develop policies to define the |
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responsibilities of an unlicensed nursing staff member and to limit |
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the unlicensed nursing staff member's duties to tasks that do not |
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require a license as a nurse. |
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(g) A hospital may not permit an unlicensed nursing staff |
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member to perform any function that requires a substantial amount |
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of scientific knowledge or technical skill, including: |
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(1) administration of medication; |
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(2) venipuncture or intravenous therapy; |
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(3) parenteral or tube feedings; |
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(4) moderately complex laboratory tests; |
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(5) invasive procedures, including inserting |
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nasogastric tubes, inserting catheters, or tracheal suctioning; |
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(6) assessing a patient's condition; and |
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(7) educating a patient or a patient's family about the |
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patient's health care problem or post-discharge care instructions. |
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(h) A hospital may use a nurse or an unlicensed nursing |
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staff member from a temporary nursing agency only if: |
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(1) the nurse or unlicensed nursing staff member meets |
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the competency requirements under Section 241.255; |
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(2) the hospital develops and follows a written |
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procedure to train and evaluate a nurse or unlicensed nursing staff |
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member from a temporary nursing agency; and |
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(3) the hospital evaluates a nurse or unlicensed |
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nursing staff member from a temporary nursing agency at least as |
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often as it evaluates a nurse or unlicensed nursing staff member who |
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is permanently employed by the hospital. |
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(i) Each hospital shall verify and document that each nurse |
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employed permanently or temporarily by the hospital is currently |
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licensed. |
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Sec. 241.257. MINIMUM NURSE STAFFING LEVELS. (a) Each |
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hospital shall have on duty at all times at least one direct care |
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registered nurse for each: |
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(1) patient care unit in the hospital; |
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(2) operating room to serve as circulating nurse who |
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is not otherwise assisting with the surgery; |
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(3) emergency department to triage a patient when the |
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patient arrives in the emergency department; |
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(4) two patients in a critical care unit, including an |
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intensive care unit, burn center, coronary care unit, or acute |
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respiratory unit that provides care to patients who require: |
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(A) continuous monitoring; |
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(B) complex nursing interventions; |
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(C) direct observation by a direct care |
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registered nurse; |
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(D) intensive assessment or evaluation; or |
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(E) specialized education for the patient or the |
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patient's family or representative; |
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(5) two patients in a newborn intensive care unit; |
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(6) patient who is in active labor or has medical or |
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obstetrical complications; |
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(7) patient who is undergoing cesarean delivery or for |
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whom epidural anesthesia is being initiated; |
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(8) three antepartum patients who are not in active |
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labor; |
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(9) three mother-baby couplets in a postpartum area of |
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the perinatal service, not to exceed six patients for each direct |
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care registered nurse in the event of a multiple birth; |
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(10) four mothers on a postpartum service for a direct |
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care registered nurse assigned to mothers only; |
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(11) five well babies in a nursery; |
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(12) newborn who is undergoing resuscitation or who |
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the direct care registered nurse determines is unstable; |
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(13) four recently born infants; |
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(14) three patients on a combined labor, delivery, and |
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postpartum area of the perinatal service, consisting of one woman |
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who is not in active labor and one postpartum mother-baby couplet; |
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(15) three patients in a pediatric service unit; |
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(16) two patients in a postanesthesia recovery unit; |
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(17) patient who is receiving conscious sedation; |
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(18) three patients in an emergency department when |
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patients are receiving treatment; |
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(19) two patients in an emergency department who are |
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eligible for admission to a critical care unit; |
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(20) trauma patient who has an injury that: |
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(A) requires a live-saving intervention; or |
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(B) poses an immediate threat to life or limb; |
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(21) three patients in a step-down unit who require: |
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(A) intermediate intensive care; |
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(B) direct monitoring by a direct care registered |
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nurse; |
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(C) multiple assessments; |
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(D) a specialized intervention, evaluation, or |
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education; |
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(E) invasive monitoring, telemetry, or |
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mechanical ventilation, but not necessarily artificial life |
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support; or |
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(F) more care than can be provided in a medical or |
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surgical care unit; |
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(22) three patients in a telemetry unit who are |
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receiving intermediate intensive care through electronic |
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monitoring and observation of cardiac electrical signals; |
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(23) four patients in a medical or surgical care unit |
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who require continuous care through direct observation and are |
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receiving 24-hour inpatient general medical care or postsurgical |
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care; |
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(24) four patients in a specialty care unit designed |
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to provide care to a specific patient population or for a specific |
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medical condition; |
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(25) four patients in a psychiatric unit; |
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(26) five patients in a rehabilitation unit designed |
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to restore an ill or injured patient to self-sufficiency or gainful |
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employment; and |
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(27) five patients in a skilled nursing facility |
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designed to provide care to a patient on a long-term basis after |
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being discharged from another hospital unit. |
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(b) Each hospital shall ensure that at least two direct care |
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registered nurses are physically present in an emergency department |
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at all times when a patient is present. |
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(c) A hospital may not at any time make any direct care |
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registered nurse responsible for the care of a greater number of |
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patients than the number specified in Subsection (a). A hospital |
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may not average the number of patients and direct care registered |
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nurses to determine compliance with Subsection (a). |
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(d) A hospital shall assign a patient to a unit or service |
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based only on the health care needs of the patient and not to affect |
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compliance with this section. |
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(e) The staffing requirements of this section apply to a |
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unit or service of a hospital that provides services similar or |
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identical to the services customarily provided by a unit or service |
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specifically named in this section, regardless of the name given to |
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the unit or service by the hospital. |
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Sec. 241.258. REQUIRED POSTING OF STAFFING PLAN; |
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RECORDS. (a) A hospital shall ensure that the following |
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information from the nurse staffing plan is posted for public view |
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at the beginning of each shift in each patient care unit: |
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(1) the nurse staffing requirement for the unit as |
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determined by the patient classification system; |
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(2) the actual nurse staffing provided on the unit; |
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and |
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(3) any variance between the nurse staffing required |
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by the patient classification system and the actual nurse staffing |
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provided on the unit. |
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(b) A hospital shall maintain a record of each direct care |
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registered nurse and licensed vocational nurse assigned to each |
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patient for each shift. |
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(c) A hospital shall: |
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(1) retain the information required to be posted under |
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Subsection (a) for a period of two years; and |
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(2) permanently retain the information required to be |
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maintained under Subsection (b). |
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Sec. 241.259. HOSPITAL PATIENT CLASSIFICATION |
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SYSTEM. (a) Each hospital shall develop and use a patient |
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classification system to determine the number of nurses and |
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unlicensed nursing staff members required for each shift in each |
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patient care unit in the hospital. The patient classification |
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system shall consider: |
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(1) the nursing care requirements of each patient in |
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the unit, based on an assessment by the patient's direct care |
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registered nurse of: |
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(A) the severity of the patient's illness or |
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injury, including any secondary diagnosis; |
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(B) the patient's need for any specialized |
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equipment or technology; |
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(C) the complexity of the clinical judgment |
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required to assess, plan, implement, and evaluate the care plan for |
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the patient; |
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(D) the patient's ability for self-care, |
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including any motor, sensory, or cognitive deficit; |
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(E) the need for patient advocacy services |
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provided by a direct care registered nurse; and |
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(F) the type of license required by the staff who |
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will care for the patient; |
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(2) the patient care delivery system in the hospital; |
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(3) the physical layout of the nursing unit; |
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(4) generally accepted standards of nursing practice; |
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(5) unique characteristics of the hospital's patient |
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population; and |
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(6) the ability of the direct care registered nursing |
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staff to effectively provide assessment, nursing diagnosis, |
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planning, and intervention to each patient. |
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(b) A hospital may not consider any fiscal or budget issue |
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in developing and implementing the patient classification system. |
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(c) The patient classification system must include a method |
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to validate the amount of nursing care needed for each category of |
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patient. |
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(d) The hospital shall develop a mechanism to test the |
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accuracy of the validation method in Subsection (c). This mechanism |
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must address the amount of nursing care needed by patient category |
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and by pattern of care delivery. The hospital shall test the |
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accuracy of the validation method at least annually, and more |
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frequently when warranted by changes in the patient population, |
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skill mix of the staff, or patient care delivery model. |
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(e) The patient classification system must be fully |
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transparent. The hospital shall submit the following information |
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to the department: |
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(1) the methodology used by the system to predict |
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nurse staffing requirements; |
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(2) each factor, assumption, and value used in the |
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methodology; |
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(3) an explanation of the scientific and empirical |
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basis for each assumption and value used in the methodology; and |
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(4) a report by a committee of direct care registered |
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nurses who work in units covered by the system on the adequacy and |
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accuracy of the information submitted by the hospital under this |
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section. |
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(f) The committee under Subsection (e)(4) shall be |
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appointed by: |
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(1) the chief nursing officer, if direct care |
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registered nurses in the hospital are not represented under a |
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collective bargaining agreement; or |
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(2) the collective bargaining agent, if direct care |
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registered nurses in the hospital are represented under a |
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collective bargaining agreement. |
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(g) The information required under Subsection (e) must be |
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accompanied by a statement by a representative of the hospital that |
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the information submitted by the hospital completely and accurately |
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reflects the implementation of a valid patient classification |
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system used to determine nurse staffing for each shift in each |
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patient care unit in the hospital. The statement must be |
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acknowledged under oath and contain an express acknowledgement that |
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a false statement constitutes fraud and a violation of Section |
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37.10, Penal Code. |
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(h) The department shall make the information submitted |
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under Subsection (e) available to the public. |
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(i) A hospital may not use any methodology, technology, |
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system, device, or computer hardware or software to determine nurse |
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staffing requirements that: |
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(1) considers any factor other than individual patient |
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need; |
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(2) employs any method or uses any information to |
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determine a patient's health care requirements other than an |
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assessment performed by the patient's direct care registered nurse; |
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(3) purports to be proprietary; or |
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(4) restricts the complete transparency and |
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disclosure of each operational element, methodology, formula, |
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assumption, and value used by the system. |
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(j) Each hospital shall develop a process by which any |
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interested staff member can provide feedback and make a |
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recommendation regarding the patient classification system. |
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Sec. 241.260. REVIEW OF PATIENT CLASSIFICATION |
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SYSTEM. (a) Each hospital shall submit its patient |
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classification system to an annual review to determine whether the |
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system accurately measures the health care needs of individual |
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patients and predicts direct care registered nurse staffing |
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requirements. |
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(b) The review shall be conducted by a committee, at least |
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half of the members of which are direct care registered nurses who |
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provide patient care in the units covered by the system. The chief |
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nursing officer of the hospital shall appoint the members of the |
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committee, except that if the direct care registered nurses in the |
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hospital are represented under a collective bargaining agreement, |
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the authorized collective bargaining agent shall appoint the direct |
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care registered nurse members of the committee. |
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(c) The committee shall report its findings to the hospital. |
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If the committee cannot agree on its findings, then the findings of |
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a majority of the direct care registered nurse members of the |
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committee shall be the committee's findings. |
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(d) The hospital shall implement any change to the patient |
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classification system recommended by the committee to improve the |
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accuracy of the system in measuring patient care needs not later |
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than the 30th day after the date the hospital receives the |
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recommendation. |
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Sec. 241.261. UNIFORM STATEWIDE PATIENT CLASSIFICATION |
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SYSTEM. The executive commissioner of the Health and Human |
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Services Commission and the Texas Board of Nursing shall jointly |
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adopt rules implementing a uniform patient classification system |
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that meets the requirements for a hospital patient classification |
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system under Section 241.259 for use by each hospital in this state. |
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Sec. 241.262. UNIFORM STATEWIDE PATIENT CLASSIFICATION |
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SYSTEM ADVISORY COMMITTEE. (a) In this section, "committee" |
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means the Uniform Statewide Patient Classification System Advisory |
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Committee. |
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(b) The committee consists of 35 members appointed jointly |
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by the department and the Texas Board of Nursing. At least 18 |
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members of the committee must be direct care registered nurses. The |
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committee shall include technical and scientific experts who are |
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capable of providing advice on the technical design and |
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implementation of a patient classification system. |
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(c) A person is not eligible to serve on the committee if the |
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person has an interest in the development, marketing, or purchasing |
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of a private patient classification system product. A person who is |
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nominated to be a member of the committee shall file with the |
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department a sworn statement disclosing any interest the person has |
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in a private patient classification system product. |
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(d) The committee shall advise the department on the design |
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and implementation of a uniform patient classification system for |
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use by each hospital in this state. Not later than the first |
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anniversary of its initial meeting, the committee shall submit a |
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report to the department and the Texas Board of Nursing with |
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recommended standards for a patient classification system for use |
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by each hospital in this state. The report must be sufficiently |
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detailed to allow the department to review and implement the |
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recommended standards. The department shall make the report |
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available to the public. |
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(e) Chapter 2110, Government Code, does not apply to the |
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size or composition of the committee. |
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(f) This section expires September 1, 2012. |
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SECTION 1.02. Sections 241.256(a)-(d), 241.257, 241.258, |
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241.259, and 241.260, Health and Safety Code, as added by this Act, |
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do not apply before March 1, 2011, to a facility designated as a |
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critical access hospital by the United States Department of Health |
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and Human Services. |
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SECTION 1.03. The executive commissioner of the Health and |
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Human Services Commission and the Texas Board of Nursing shall |
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jointly adopt rules under Section 241.261, Health and Safety Code, |
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as added by this Act, not later than March 1, 2011. |
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ARTICLE 2. OTHER AMENDMENTS TO HEALTH AND SAFETY CODE |
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SECTION 2.01. Section 161.0315, Health and Safety Code, is |
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amended by adding Subsection (b-1) to read as follows: |
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(b-1) A medical peer review committee or medical committee |
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may not conduct peer review of a direct care registered nurse or |
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evaluate the license, employment, or practice of a direct care |
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registered nurse, as that term is defined by Section 241.252. |
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SECTION 2.02. Section 241.026, Health and Safety Code, is |
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amended by amending Subsections (a) and (c) and adding Subsection |
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(g) to read as follows: |
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(a) The board shall adopt and enforce rules to further the |
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purposes of this chapter. The rules at a minimum shall address: |
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(1) minimum requirements for staffing by physicians |
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[and nurses]; |
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(2) hospital services relating to patient care; |
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(3) fire prevention, safety, and sanitation |
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requirements in hospitals; |
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(4) patient care and a patient bill of rights; |
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(5) compliance with other state and federal laws |
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affecting the health, safety, and rights of hospital patients; |
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[and] |
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(6) implementation and enforcement of the minimum |
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requirements for staffing by nurses under Section 241.257; and |
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(7) implementation and enforcement of the minimum |
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standards for competent practice by a nurse or unlicensed nursing |
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staff member under Section 241.255 [compliance with nursing peer
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review under Subchapter I, Chapter 301, and Chapter 303,
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Occupations Code, and the rules of the Texas Board of Nursing
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relating to peer review]. |
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(c) Except as provided by Subsection (g), on [Upon] the |
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recommendation of the hospital licensing director and the council, |
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the board by order may waive or modify the requirement of a |
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particular provision of this Act or minimum standard adopted by |
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board rule under this section to a particular general or special |
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hospital if the board determines that the waiver or modification |
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will facilitate the creation or operation of the hospital and that |
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the waiver or modification is in the best interests of the |
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individuals served or to be served by the hospital. |
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(g) The board may not waive or modify the requirements of |
|
Section 241.257 unless the board makes express written findings, |
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supported by a written record and issued after public notice and a |
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reasonable opportunity for public comment, that the waiver: |
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(1) will not jeopardize the health, safety, and |
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well-being of patients affected by the waiver; and |
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(2) is needed to increase the operational efficiency |
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of the hospital. |
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SECTION 2.03. Section 241.051(a), Health and Safety Code, |
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is amended to read as follows: |
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(a) The department may make any inspection, survey, or |
|
investigation that it considers necessary. A representative of the |
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department may enter the premises of a hospital at any [reasonable] |
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time, with or without advance notice, to make an inspection, a |
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survey, or an investigation to assure compliance with or prevent a |
|
violation of this chapter, the rules adopted under this chapter, an |
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order or special order of the commissioner of health, a special |
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license provision, a court order granting injunctive relief, or |
|
other enforcement procedures. The department shall maintain the |
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confidentiality of hospital records as applicable under state or |
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federal law. |
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SECTION 2.04. Section 241.052, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 241.052. COMPLIANCE WITH RULES AND STANDARDS. (a) A |
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hospital that is in operation when an applicable rule or minimum |
|
standard is adopted under this chapter must be given a reasonable |
|
amount of additional time [period] within which to comply with the |
|
rule or standard if the hospital applies to the department for a |
|
waiver of the immediate application of the rule and the department |
|
determines that good cause exists to delay the application of the |
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rule to the hospital. |
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(b) The period for compliance may not exceed six months, |
|
except that the department may extend the period for compliance in |
|
30-day increments up to an additional [beyond] six months if the |
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hospital sufficiently shows the department that it requires |
|
additional time to complete compliance with the rule or standard |
|
due to a circumstance beyond the hospital's control. The board may |
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not extend the period for compliance with Section 241.257 beyond |
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six months. |
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SECTION 2.05. Section 241.055, Health and Safety Code, is |
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amended by amending Subsections (b) and (c) and by adding |
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Subsections (b-1), (b-2), and (e) to read as follows: |
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(b) A hospital that violates Chapter 301, Occupations Code, |
|
Subsection (a) of this section, another provision of this chapter, |
|
or a rule adopted or enforced under this chapter is liable for a |
|
civil penalty of not more than $25,000 [$1,000] for each day of |
|
violation and for each act of violation. A hospital that violates |
|
this chapter or a rule or order adopted under this chapter relating |
|
to the provision of mental health, chemical dependency, or |
|
rehabilitation services is liable for a civil penalty of not more |
|
than $25,000 for each day of violation and for each act of |
|
violation. |
|
(b-1) A hospital that violates Subchapter I is liable for a |
|
civil penalty of not more than $25,000 for each act of violation of |
|
that subchapter. The hospital is liable for an additional $10,000 |
|
for each shift in each patient care unit that has staffing levels in |
|
violation of Sections 241.256 and 241.257. |
|
(b-2) A hospital that interferes with a nurse's duty and |
|
right of patient advocacy under Section 301.356, Occupations Code, |
|
is liable for a civil penalty of not more than $25,000 for each act |
|
of violation. |
|
(c) In determining the amount of the penalty, the district |
|
court shall consider: |
|
(1) the hospital's degree of culpability and history |
|
of prior offenses [previous violations]; |
|
(2) the seriousness of the violation, including the |
|
nature, circumstances, extent, and gravity of the violation; |
|
(3) whether the health and safety of the public was |
|
threatened by the violation; |
|
(4) any actual harm or injury caused or threatened by |
|
the violation, including any exposure of licensed personnel to: |
|
(A) a breach of professional responsibility; |
|
(B) potential license suspension or revocation; |
|
or |
|
(C) malpractice liability; [the demonstrated
|
|
good faith of the hospital; and] |
|
(5) the amount necessary to deter future violations; |
|
(6) the effort and expense incurred by a person |
|
presenting, providing essential information for, or assisting in |
|
the presentation of the claim; and |
|
(7) any other matter that justice may require. |
|
(e) The court may order any additional remedy, sanction, or |
|
corrective action that the court finds is necessary to remedy the |
|
violation and prevent future violations. |
|
SECTION 2.06. Section 241.056, Health and Safety Code, is |
|
amended by amending Subsection (a) and adding Subsection (a-1) to |
|
read as follows: |
|
(a) A person who is harmed by a violation under Section |
|
241.028 or 241.055 or Subchapter I, and a person exposed to a risk |
|
of harm by a violation of Subchapter I, may petition a district |
|
court for appropriate injunctive relief. |
|
(a-1) In addition, a nurse or other person who is harmed or |
|
exposed to a risk of harm by a violation of Subchapter I may file a |
|
suit to recover: |
|
(1) the greater of: |
|
(A) the actual damages incurred by the person, |
|
including damages for mental anguish, regardless of whether other |
|
injury is shown; or |
|
(B) $25,000 per violation; |
|
(2) exemplary damages; |
|
(3) court costs; and |
|
(4) reasonable attorney's fees. |
|
SECTION 2.07. Section 241.059(a), Health and Safety Code, |
|
is amended to read as follows: |
|
(a) The commissioner of health may assess an administrative |
|
penalty against a hospital that violates this chapter, a rule |
|
adopted pursuant to this chapter, a special license provision, an |
|
order or emergency order issued by the commissioner or the |
|
commissioner's designee, or another enforcement procedure |
|
permitted under this chapter. The commissioner shall assess an |
|
administrative penalty against a hospital that violates Section |
|
166.004. The penalty under this section may be assessed in addition |
|
to any penalty assessed under Section 241.055. |
|
SECTION 2.08. The executive commissioner of the Health and |
|
Human Services Commission shall adopt rules required under Section |
|
241.026(a), Health and Safety Code, as added by this Act, not later |
|
than December 1, 2009. |
|
ARTICLE 3. DIRECT CARE REGISTERED NURSES |
|
SECTION 3.01. Chapter 301, Occupations Code, is amended by |
|
adding Subchapter N to read as follows: |
|
SUBCHAPTER N. DIRECT CARE REGISTERED NURSE |
|
Sec. 301.651. DIRECT CARE REGISTERED NURSE. (a) A person is |
|
a direct care registered nurse if the person: |
|
(1) is currently licensed to practice professional |
|
nursing under this chapter; |
|
(2) has documented clinical competence under Section |
|
241.255, Health and Safety Code; and |
|
(3) accepts a direct, hands-on patient care |
|
assignment. |
|
(b) A manager or supervisor is not a direct care registered |
|
nurse. |
|
Sec. 301.652. PRACTICE BY DIRECT CARE REGISTERED NURSE. (a) |
|
A direct care registered nurse shall: |
|
(1) employ scientific knowledge and experience in the |
|
physical, social, and biological sciences; |
|
(2) exercise independent judgment in applying the |
|
nursing process; and |
|
(3) directly provide: |
|
(A) continuous assessment of each patient's |
|
condition based on the direct care registered nurse's independent |
|
professional judgment; |
|
(B) planning, clinical supervision, |
|
implementation, and evaluation of the nursing care provided to each |
|
patient, or assign these tasks under the guidelines prescribed by |
|
Subsection (b); and |
|
(C) assessment, planning, implementation, and |
|
evaluation of patient education, including discharge instructions |
|
for each patient, or personally assign these tasks to another nurse |
|
or to an unlicensed nursing staff member. |
|
(b) A direct care registered nurse may assign the |
|
implementation of nursing care to another licensed nurse or to an |
|
unlicensed nursing staff member if: |
|
(1) the direct care registered nurse does not assign a |
|
task to a person who is not licensed to perform the task; |
|
(2) the person to whom the task is assigned is prepared |
|
to and capable of competently performing the task; |
|
(3) the assignment of the task is not prohibited by |
|
law; and |
|
(4) the direct care registered nurse is able to |
|
effectively supervise the nursing care provided by the person |
|
assigned the task. |
|
(c) A direct care registered nurse shall initiate the |
|
planning and delivery of patient care at the time a patient is |
|
admitted. The direct care registered nurse shall ensure that the |
|
planning and delivery of patient care reflects all elements of the |
|
nursing process, including assessment, planning, intervention, |
|
evaluation, and patient advocacy. |
|
(d) A direct care registered nurse shall develop a nursing |
|
care plan for each patient through coordination with the patient, |
|
the patient's family, or the patient's representative, as |
|
appropriate, and other health care professionals involved in the |
|
care of the patient. |
|
(e) A direct care registered nurse shall evaluate the |
|
effectiveness of each patient's nursing care plan through |
|
communication with the patient and other health care professionals |
|
and through assessment of the patient's physical condition, |
|
behavior, signs and symptoms of illness, and reactions to |
|
treatment. The direct care registered nurse shall modify the |
|
nursing care plan when necessary. |
|
(f) A direct care registered nurse may not engage in the |
|
practice known as "charting by exception." The direct care |
|
registered nurse shall permanently record in each patient's medical |
|
record information about: |
|
(1) the nursing diagnosis; |
|
(2) the nursing plan; |
|
(3) interventions made by the nurse; |
|
(4) patient advocacy undertaken by the nurse; |
|
(5) evaluations of the patient made by the nurse; |
|
(6) the patient's initial assessment; |
|
(7) reassessments of the patient; |
|
(8) the patient's condition; |
|
(9) observations of the patient; and |
|
(10) data about the patient's care. |
|
Sec. 301.653. PATIENT ASSESSMENT. (a) A nurse may not |
|
perform patient assessment unless the nurse is a direct care |
|
registered nurse. A nurse, other than a direct care registered |
|
nurse, or an unlicensed nursing staff member may assist a direct |
|
care registered nurse with data collection. |
|
(b) Patient assessment includes: |
|
(1) direct observation of the patient's: |
|
(A) signs and symptoms of illness; |
|
(B) reaction to treatment; |
|
(C) behavior; and |
|
(D) physical condition; |
|
(2) interpretation of information obtained from the |
|
patient and others, including other health care professionals; and |
|
(3) collection, analysis, synthesis, and evaluation |
|
of data about a patient. |
|
Sec. 301.654. INDEPENDENT JUDGMENT. (a) A direct care |
|
registered nurse shall exercise independent judgment in the best |
|
interest of the patient. |
|
(b) A direct care registered nurse may not allow a |
|
commercial or revenue generation motive of the hospital or of a |
|
person employing the direct care registered nurse to encumber the |
|
independent judgment of the direct care registered nurse. |
|
Sec. 301.655. CLINICAL SUPERVISION. (a) A direct care |
|
registered nurse who assigns a nursing care task to another nurse or |
|
to an unlicensed nursing staff member shall: |
|
(1) ensure that the person to be assigned the task |
|
possesses the necessary training, experience, and capability to |
|
competently and safely perform the task to be assigned; and |
|
(2) effectively supervise the clinical functions and |
|
nursing care tasks performed by the person assigned the task. |
|
(b) A direct care registered nurse shall provide clinical |
|
supervision in the best interest of the patient and may not allow a |
|
commercial or revenue generation motive of the hospital or a person |
|
employing the direct care registered nurse to encumber the |
|
performance of clinical supervision by the direct care registered |
|
nurse. |
|
Sec. 301.656. PATIENT CARE ASSIGNMENTS. (a) A direct |
|
care registered nurse is always responsible for providing safe, |
|
therapeutic, and competent nursing care to each patient assigned to |
|
the direct care registered nurse. |
|
(b) A direct care registered nurse may not accept a patient |
|
assignment unless the direct care registered nurse reasonably |
|
believes the direct care registered nurse has the knowledge, |
|
judgment, skills, and ability necessary to provide the care |
|
required by the patient. A direct care registered nurse may not |
|
accept a patient in any clinical unit or with any diagnosis, |
|
condition, prognosis, or other determinative characteristic of |
|
nursing care for which the direct care registered nurse does not |
|
reasonably believe the direct care registered nurse can provide |
|
clinically competent nursing care. |
|
(c) The refusal by a direct care registered nurse to accept |
|
a patient care assignment under this section is an exercise of the |
|
duty and right of patient advocacy under Section 301.356 and is |
|
entitled to the protections provided by Section 301.357. |
|
Sec. 301.657. ACCEPTANCE OF ORDERS. (a) Before |
|
implementation, a direct care registered nurse must review each |
|
order for patient care services, including an order for the |
|
administration of medication, a therapeutic agent, treatment, |
|
disease prevention, or rehabilitative regimen, to determine if the |
|
order is: |
|
(1) in the best interest of the patient; |
|
(2) initiated by a person legally authorized to issue |
|
the order; and |
|
(3) in accordance with the law. |
|
(b) If a direct care registered nurse determines that an |
|
order does not meet the requirements of Subsection (a) or has doubt |
|
regarding the meaning of the order or the conformance of the order |
|
with the requirements of Subsection (a), the direct care registered |
|
nurse shall seek clarification from the person who initiated the |
|
order, the patient's physician, or another appropriate health care |
|
professional. The direct care registered nurse may not implement |
|
the order until the direct care registered nurse has obtained |
|
clarification sufficient to determine that the order meets the |
|
requirements of Subsection (a). |
|
(c) If, after receiving clarification of an order under |
|
Subsection (b), a direct care registered nurse continues to believe |
|
that the requirements for implementation of the order under |
|
Subsection (a) have not been satisfied, the direct care registered |
|
nurse may refuse to implement the order on the basis that the order |
|
is not in the best interest of the patient. |
|
(d) A direct care registered nurse who seeks clarification |
|
of an order under Subsection (b) or refuses to implement an order |
|
under Subsection (c) is exercising the duty and right of patient |
|
advocacy under Section 301.356 and is entitled to the protections |
|
provided by Section 301.357. |
|
Sec. 301.658. WHISTLE-BLOWER PROTECTION. (a) A direct |
|
care registered nurse may report to the hospital, an outside |
|
authority, or the public an action, policy, or condition created by |
|
a hospital or other person in the health care industry that the |
|
direct care registered nurse believes: |
|
(1) violates the law; |
|
(2) breaches professional ethics; |
|
(3) impedes competent and safe nursing practice or |
|
patient care; |
|
(4) contributes to an adverse patient outcome or |
|
incident; |
|
(5) contributes to a sentinel or reportable event; |
|
(6) is an issue that must be reported to satisfy the |
|
direct care registered nurse's duty and right of patient advocacy |
|
under Section 301.356; or |
|
(7) is a valid argument in support of or against a |
|
hospital policy or practice relating to the delivery of nursing |
|
care. |
|
(b) A person may not take an adverse personnel action or |
|
discriminate against a direct care registered nurse who makes a |
|
report authorized under Subsection (a). |
|
(c) A direct care registered nurse who makes a report |
|
authorized under Subsection (a) is exercising the duty and right of |
|
patient advocacy under Section 301.356 and is entitled to the |
|
protections provided by Section 301.357. |
|
(d) This section does not authorize the disclosure of |
|
confidential patient information, unless the disclosure is: |
|
(1) consented to by the patient; |
|
(2) required by law; or |
|
(3) provided in confidence to a government, |
|
regulatory, or accreditation agency as part of a complaint or |
|
investigation. |
|
Sec. 301.659. COLLECTIVE PATIENT ADVOCACY. (a) Direct |
|
care registered nurses may work collectively to exercise the duty |
|
and right of patient advocacy. |
|
(b) In collectively exercising the duty and right of patient |
|
advocacy, direct care registered nurses have the right to: |
|
(1) self-organize; |
|
(2) seek representation to engage in collective |
|
bargaining with their hospital employer; |
|
(3) seek any form of mutual aid or protection; and |
|
(4) form, join, or participate in: |
|
(A) an independent hospital-based professional |
|
practice committee; |
|
(B) a general or specialty registered nursing |
|
professional association; |
|
(C) a patient advocacy organization; or |
|
(D) a labor organization. |
|
(c) A direct care registered nurse who engages in patient |
|
advocacy collectively with other direct care registered nurses is |
|
exercising the duty and right of patient advocacy under Section |
|
301.356 and is entitled to the protections provided by Section |
|
301.357. |
|
ARTICLE 4. OTHER AMENDMENTS TO OCCUPATIONS CODE |
|
SECTION 4.01. Section 301.352, Occupations Code, is amended |
|
by amending Subsections (a) and (a-1) and adding Subsection (e) to |
|
read as follows: |
|
(a) A person may not suspend, terminate, take an adverse |
|
personnel action against, or otherwise discipline or discriminate |
|
against a nurse who refuses to engage in an act or omission relating |
|
to patient care if the nurse reasonably believes the act or omission |
|
would: |
|
(1) be harmful to the patient; |
|
(2) not be in the best interest of the patient; |
|
(3) constitute grounds for reporting the hospital to |
|
the Department of State Health Services under Section 301.402; or |
|
(4) violate any provision of this chapter or a board |
|
rule [as provided by Subsection (a-1)]. |
|
(a-1) Subsection (a) applies only [A nurse may refuse 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 of [that] the reason for refusing to engage |
|
in [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]. |
|
(e) A nurse who refuses to engage in an act or omission under |
|
this section is exercising the duty and right of patient advocacy |
|
under Section 301.356 and is entitled to the protections provided |
|
by Section 301.357. |
|
SECTION 4.02. Subchapter H, Chapter 301, Occupations Code, |
|
is amended by adding Section 301.356 to read as follows: |
|
Sec. 301.356. DUTY AND RIGHT OF PATIENT ADVOCACY. (a) A |
|
nurse has the duty and the right to act as an advocate for each |
|
patient assigned to the nurse. |
|
(b) As circumstances require, a nurse shall: |
|
(1) take action to improve the care provided to the |
|
patient; |
|
(2) try to change a decision or action that is not in |
|
the best interest of the patient; and |
|
(3) give the patient the opportunity to make an |
|
informed decision about the care to be provided to the patient. |
|
SECTION 4.03. Subchapter H, Chapter 301, Occupations Code, |
|
is amended by adding Section 301.357 to read as follows: |
|
Sec. 301.357. CAUSE OF ACTION FOR INTERFERENCE WITH PATIENT |
|
ADVOCACY. (a) A person may not take an adverse personnel action or |
|
discriminate against a nurse who exercises the duty and right of |
|
patient advocacy under Section 301.356. |
|
(b) A nurse may bring a cause of action against a person who |
|
violates Subsection (a) to recover: |
|
(1) the greater of: |
|
(A) the actual damages incurred by the nurse, |
|
including damages for mental anguish regardless of whether other |
|
injury is shown; or |
|
(B) $10,000; |
|
(2) exemplary damages; |
|
(3) court costs; and |
|
(4) reasonable attorney's fees. |
|
(c) In addition to the amount recovered under Subsection |
|
(b), a nurse whose employment is suspended or terminated in |
|
violation of Subsection (a) is entitled to: |
|
(1) reinstatement in the nurse's former position, or |
|
severance pay in an amount equal to three months of the nurse's most |
|
recent salary; and |
|
(2) compensation for wages lost during the period of |
|
suspension or termination. |
|
(d) A nurse who brings an action under this section has the |
|
burden of proving that: |
|
(1) the nurse engaged in an act or omission that |
|
constituted an exercise of the duty and right of patient advocacy; |
|
and |
|
(2) the nurse's exercise of the duty and right of |
|
patient advocacy was a substantial factor in the person's decision |
|
to take an adverse personnel action or discriminate against the |
|
nurse. |
|
(e) There is a rebuttable presumption that a nurse's |
|
exercise of the duty and right of patient advocacy was a substantial |
|
factor in a person's decision to take an adverse personnel action or |
|
discriminate against the nurse if the person took the adverse |
|
personnel action or discriminated against the nurse on or before |
|
the 60th day after the date the nurse engaged in the act or omission |
|
constituting an exercise of the duty and right of patient advocacy. |
|
(f) An action under this section may be brought in the |
|
district court of the county in which: |
|
(1) the plaintiff resides; |
|
(2) the plaintiff was employed by the defendant; or |
|
(3) any defendant conducts business. |
|
SECTION 4.04. Subchapter H, Chapter 301, Occupations Code, |
|
is amended by adding Section 301.358 to read as follows: |
|
Sec. 301.358. FIDUCIARY DUTY. (a) A nurse owes a fiduciary |
|
duty to each patient assigned to the nurse to act exclusively in the |
|
best interest of the patient. A nurse may not be influenced in the |
|
provision of nursing care to the patient by: |
|
(1) the nurse's own interests; |
|
(2) the interests of any third party; |
|
(3) the directives of any interested third party; or |
|
(4) any motive other than the nurse's responsibility |
|
to provide safe and competent nursing care in the best interest and |
|
for the benefit of the patient. |
|
(b) A nurse may refuse to engage in conduct that violates |
|
the nurse's fiduciary duty to a patient. A nurse who refuses to |
|
engage in conduct that violates the fiduciary duty owed to a patient |
|
is exercising the duty and right of patient advocacy under Section |
|
301.356 and is entitled to the protections provided by Section |
|
301.357. |
|
SECTION 4.05. Sections 301.402(b) and (d), Occupations |
|
Code, are amended to read as follows: |
|
(b) A nurse who provides or supervises the care of a patient |
|
in a hospital shall report to the Department of State Health |
|
Services [board] in the manner prescribed under Subsection (d) when |
|
[if] the nurse has reasonable cause to suspect that the hospital has |
|
policies or is engaging in practices that: |
|
(1) interfere with the ability of a nurse to perform |
|
the duties of professional nursing [another nurse has engaged in
|
|
conduct subject to reporting]; [or] |
|
(2) discourage a nurse through intimidation or |
|
coercion from exercising the duty and right of patient advocacy |
|
under Section 301.356; |
|
(3) violate a standard of safe, competent, and |
|
therapeutic nursing care established by law; or |
|
(4) expose a patient to a substantial risk of harm [the
|
|
ability of a nursing student to perform the services of the nursing
|
|
profession would be, or would reasonably be expected to be,
|
|
impaired by chemical dependency]. |
|
(d) A report by a nurse under Subsection (b) must: |
|
(1) be written and signed; and |
|
(2) include the following information: |
|
(A) the name and address of the hospital; |
|
(B) the name of the most senior manager of the |
|
hospital; |
|
(C) the name of the chief nursing officer; |
|
(D) a description of the policy or practice the |
|
nurse is reporting; [identity of the nurse or student] and |
|
(E) any additional information required by the |
|
board. |
|
SECTION 4.06. Section 301.411(a), Occupations Code, is |
|
amended to read as follows: |
|
(a) A nurse [person] is not liable in a civil action for |
|
failure to file a report required by this subchapter. |
|
SECTION 4.07. Section 301.412, Occupations Code, is amended |
|
to read as follows: |
|
Sec. 301.412. REPORTING IMMUNITY. A nurse [person] who[,
|
|
without malice,] makes a report required or authorized, or |
|
reasonably believed to be required or authorized, under this |
|
subchapter and a person who provides records, information, or |
|
assistance to the nurse making the report: |
|
(1) is immune from civil liability based on: |
|
(A) the act of making the report; and |
|
(B) the contents of the report; and |
|
(2) may not be subjected to other retaliatory action |
|
as a result of making the report. |
|
SECTION 4.08. Section 301.413, Occupations Code, is amended |
|
by amending Subsections (a) through (e) and adding Subsection (b-1) |
|
to read as follows: |
|
(a) A person named as a defendant in a civil action or |
|
subjected to other retaliatory action as a result of making |
|
[filing] a report or providing records, information, or assistance |
|
in support of a report required, authorized, or reasonably believed |
|
to be required or authorized under this subchapter [as a result of
|
|
refusing to engage in conduct as authorized by Section 301.352, or
|
|
as a result of requesting in good faith a nursing peer review
|
|
determination under Section 303.005,] may file a counterclaim in |
|
the pending action or prove a cause of action in a subsequent suit |
|
to recover defense costs, including reasonable attorney's fees and |
|
actual and punitive damages, if the suit or retaliatory action is |
|
determined to be frivolous, unreasonable, or taken in bad faith. |
|
(b) A person may not suspend or terminate the employment of, |
|
or otherwise discipline or discriminate against, a nurse [person] |
|
who[:
|
|
[(1)] reports, without malice, under this |
|
subchapter[; or
|
|
[(2)
requests, in good faith, a nursing peer review
|
|
determination under Section 303.005]. |
|
(b-1) A nurse reports with malice under Subsection (b) if, |
|
at the time the nurse makes the report, the nurse: |
|
(1) knows the report is false; or |
|
(2) has serious doubts about whether the report is |
|
true. |
|
(c) A nurse [person] who reports under this subchapter[,
|
|
refuses to engage in conduct as authorized by Section 301.352, or
|
|
requests a nursing peer review determination under Section 303.005] |
|
has a cause of action against a person who violates Subsection (b), |
|
and may recover: |
|
(1) the greater of: |
|
(A) actual damages, including damages for mental |
|
anguish even if no other injury is shown; or |
|
(B) $5,000; |
|
(2) exemplary damages; |
|
(3) court costs; and |
|
(4) reasonable attorney's fees. |
|
(d) In addition to the amount recovered under Subsection |
|
(c), a nurse [person] whose employment is suspended or terminated |
|
in violation of this section is entitled to: |
|
(1) reinstatement in the nurse's [employee's] former |
|
position or severance pay in an amount equal to three months of the |
|
nurse's [employee's] most recent salary; and |
|
(2) compensation for wages lost during the period of |
|
suspension or termination. |
|
(e) A nurse [person] who brings an action under this section |
|
has the burden of proof. It is a rebuttable presumption that the |
|
nurse's [person's] employment was suspended or terminated for |
|
reporting under this subchapter[, for refusing to engage in conduct
|
|
as authorized by Section 301.352, or for requesting a peer review
|
|
committee determination under Section 303.005] if: |
|
(1) the nurse [person] was suspended or terminated |
|
within 60 days after the date the report[, refusal, or request] was |
|
made; and |
|
(2) the board, the commissioner of the Department of |
|
State Health Services, or a court determines that[:
|
|
[(A)] the report that is the subject of the cause |
|
of action was[:
|
|
[(i)] authorized or required under Section |
|
301.402[, 301.4025, 301.403, 301.405, 301.406, 301.407, 301.408,
|
|
301.409, or 301.410; and
|
|
[(ii) made without malice;
|
|
[(B)
the request for a peer review committee
|
|
determination that is the subject of the cause of action was:
|
|
[(i) authorized under Section 303.005; and
|
|
[(ii) made in good faith; or
|
|
[(C)
the refusal to engage in conduct was
|
|
authorized by Section 301.352]. |
|
SECTION 4.09. Section 301.452(b), Occupations Code, is |
|
amended to read as follows: |
|
(b) A person is subject to denial of a license or to |
|
disciplinary action under this subchapter for: |
|
(1) a violation of this chapter, a rule or regulation |
|
not inconsistent with this chapter, or an order issued under this |
|
chapter; |
|
(2) fraud or deceit in procuring or attempting to |
|
procure a license to practice professional nursing or vocational |
|
nursing; |
|
(3) a conviction for, or placement on deferred |
|
adjudication community supervision or deferred disposition for, a |
|
felony or for a misdemeanor involving moral turpitude; |
|
(4) conduct that results in the revocation of |
|
probation imposed because of conviction for a felony or for a |
|
misdemeanor involving moral turpitude; |
|
(5) use of a nursing license, diploma, or permit, or |
|
the transcript of such a document, that has been fraudulently |
|
purchased, issued, counterfeited, or materially altered; |
|
(6) impersonating or acting as a proxy for another |
|
person in the licensing examination required under Section 301.253 |
|
or 301.255; |
|
(7) directly or indirectly aiding or abetting an |
|
unlicensed person in connection with the unauthorized practice of |
|
nursing; |
|
(8) revocation, suspension, or denial of, or any other |
|
action relating to, the person's license or privilege to practice |
|
nursing in another jurisdiction; |
|
(9) intemperate use of alcohol or drugs that the board |
|
determines endangers or could endanger a patient; |
|
(10) unprofessional or dishonorable conduct that, in |
|
the board's opinion, is likely to deceive, defraud, or injure a |
|
patient or the public; |
|
(11) adjudication of mental incompetency; |
|
(12) lack of fitness to practice because of a mental or |
|
physical health condition that could result in injury to a patient |
|
or the public; [or] |
|
(13) failure to care adequately for a patient or to |
|
conform to the minimum standards of acceptable nursing practice in |
|
a manner that, in the board's opinion, exposes a patient or other |
|
person unnecessarily to risk of harm; or |
|
(14) failure to take an action that is reasonable for |
|
the nurse to take considering the nurse's position in the hospital |
|
to correct a policy or practice in the administration of nursing |
|
care in the hospital that: |
|
(A) does not conform to a reasonable minimum |
|
standard of nursing practice and safe patient care; |
|
(B) violates a law or accreditation standard; or |
|
(C) exposes a patient to a substantial risk of |
|
harm. |
|
SECTION 4.10. The following sections of the Occupations |
|
Code are repealed: |
|
(1) Sections 301.352(b) and (f); |
|
(2) Section 301.401; |
|
(3) Sections 301.402(e) and (f); |
|
(4) Section 301.4025; |
|
(5) Section 301.403; |
|
(6) Section 301.404; |
|
(7) Section 301.405; |
|
(8) Section 301.406; |
|
(9) Section 301.407; |
|
(10) Section 301.408; |
|
(11) Section 301.409; |
|
(12) Section 301.410; |
|
(13) Section 301.4105; |
|
(14) Section 301.4106; |
|
(15) Section 301.411(b); |
|
(16) Section 301.414; |
|
(17) Section 301.415; |
|
(18) Section 301.416; |
|
(19) Section 301.417; |
|
(20) Section 301.418; and |
|
(21) Section 301.419. |
|
SECTION 4.11. Chapter 303, Occupations Code, is repealed. |
|
ARTICLE 5. CONFORMING AMENDMENTS |
|
SECTION 5.01. Section 103.003(b), Labor Code, is amended to |
|
read as follows: |
|
(b) An employer may not disclose information about a |
|
licensed nurse or licensed vocational nurse that relates to conduct |
|
that is protected under Section 301.352 [or 303.005], Occupations |
|
Code. The employer must provide an affected nurse an opportunity to |
|
submit a statement of reasonable length to the employer to |
|
establish the application of Section 301.352 [or 303.005], |
|
Occupations Code. |
|
SECTION 5.02. Section 301.002(1-b), Occupations Code, is |
|
amended to read as follows: |
|
(1-b) "Patient safety committee" means a committee |
|
established by an association, school, agency, health care |
|
facility, or other organization to address issues relating to |
|
patient safety, including: |
|
(A) the entity's medical staff composed of |
|
individuals licensed under Subtitle B; or |
|
(B) a medical committee under Subchapter D, |
|
Chapter 161, Health and Safety Code [has the meaning assigned by
|
|
Section 303.001]. |
|
SECTION 5.03. Section 301.160(i), Occupations Code, is |
|
amended to read as follows: |
|
(i) Except as provided by this subsection, in developing or |
|
approving a pilot program under this section the board may exempt |
|
the program from rules adopted under this chapter. [Subchapter I
|
|
and Chapter 303 apply to pilot programs, except that Sections
|
|
303.002(e), 303.003, and 303.008(b) do not apply to a pilot program
|
|
using proactive peer review. The board may establish alternative
|
|
criteria for nursing peer review committees conducting proactive
|
|
peer review.] |
|
SECTION 5.04. Section 301.1605(c), Occupations Code, is |
|
amended to read as follows: |
|
(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: |
|
(1) the education requirements of this chapter unless |
|
the program includes alternate but substantially equivalent |
|
requirements; or |
|
(2) [the mandatory] reporting requirements unless the |
|
program: |
|
(A) is designed to evaluate the efficiency of |
|
alternative reporting methods; and |
|
(B) provides consumers adequate protection from |
|
registered nurses whose continued practice is a threat to public |
|
safety. |
|
SECTION 5.05. Section 301.1606(b), Occupations Code, is |
|
amended to read as follows: |
|
(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). |
|
ARTICLE 6. EFFECTIVE DATE |
|
SECTION 6.01. (a) Except as provided by Subsections (b) and |
|
(c) of this section, this Act takes effect September 1, 2009. |
|
(b) Section 241.254, Health and Safety Code, as added by |
|
this Act, takes effect January 1, 2010. |
|
(c) Sections 241.256(a), 241.257, 241.258, 241.259, and |
|
241.260, Health and Safety Code, as added by this Act, take effect |
|
March 1, 2010. |