The Texas Board of Nursing (BON) recognizes that nursing is a dynamic, ever-changing practice, which is why the Board does not offer a list of procedures that nurses at certain levels can or cannot perform. Whether a specific activity or procedure is within a nurse’s scope of practice is dependent upon a number of variables.
A nurse always has a fundamental duty to ensure safe patient care. In determining the scope of practice, nurses must consider their legal scope of practice (licensure level), the standard of care, and their individual background, knowledge, and skills. Throughout their careers, it is important for nurses to recognize when they reach their personal limits on the scope of practice.

Scope of Practice Decision-Making Model for Texas Nurses

In response to frequent scope-related inquiries, the BON recently adopted major revisions of the previous Six-Step Decision-Making Model from 1994. In developing this new resource tool, Board staff reviewed the scope of practice-related resources from 20 different state nursing boards and the National Council of State Boards of Nursing Scope of Practice Decision-Making Framework.
The BON recommends that all nurses utilize the Scope of Practice Decision-Making Model (DMM) when deciding if an employer’s assignment is safe and legally within the nurse’s scope of practice.
The Scope of Practice DMM contains 8 questions to assist nurses in making a sound scope of practice decision. If the answer to the question is “no,” then the nurse should stop – and not continue forward with that particular activity, task, procedure, role, or intervention in question. The DMM questions are as follows:

  1. Is the activity or intervention prohibited by the Texas NPA, Board Rules, guidelines, or position statements, or any law, rule, or regulation from any agency?
  2. Is the activity or intervention authorized by a valid order?
  3. Is the activity or intervention consistent with current policies and procedures in your employing organization or facility?
  4. Is performing the activity or intervention consistent with current: A) evidence-based practice findings and/or guidelines, or B) scope of practice or position statements from national nursing organizations?
  5. Is there documented evidence of your current competence (education, knowledge, skills, abilities, experience, and judgments) to perform the activity or intervention safely and effectively, in accordance with the accepted nursing standard of care?
  6. Would a reasonable and prudent nurse perform the activity or intervention in a similar circumstance?
  7. Are you prepared to accept accountability for the provision of safe care and the outcome of the care rendered?
  8. If you are an LVN, will adequate supervision be available? (Skip this question if you are an RN.)

If the answer to these 8 questions is “no,” then the DMM states: “You may proceed with performance of the activity or intervention in accordance with prevailing standards of safe nursing care.” The DMM also includes two pages of supplemental information, which offers nurses resources and other considerations to explore.
Review the Scope of Practice Decision-Making Model here. Practice within your scope and area of practice because every nurse in Texas is expected to ensure that the nursing care they provide meets standards of safety and effectiveness.

Experienced Nursing License Defense Attorneys

If you have been notified of a complaint filed against you with the Texas Board of Nursing, BERTOLINO LLP can help. We are experienced BON license defense attorneys and we know how to navigate BON’s complaint process. We are prepared to represent you at any legal hearing or proceeding regarding your professional license.
Our firm believes that immediately consulting an experienced Board of Nursing license defense attorney to review allegations of misconduct helps ensure the most favorable outcome in your case. Our results speak for themselves.
BERTOLINO LLP represents licensed professionals across the entire State of Texas. If you are facing disciplinary action from a professional licensing board, contact us today or call (512) 476-5757 and schedule a case evaluation.
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