# What Texas Nurses Should Know About the Scope of Practice Decision-Making Model | Bertolino

[Nursing License Defense](https://www.belolaw.com/blog/category/nursing-license/)   Mar 29 2026

### The [Texas Board of Nursing (BON)](https://www.bon.texas.gov/) ensures that licensed nurses comply with the rules and regulations that govern the nursing profession. As a result, BON receives, investigates, and pursues disciplinary complaints against licensees if necessary.

### If the BON ultimately decides that you have violated a rule or law, you could face sanctions that are extremely damaging to your license and career. A [nursing license defense attorney](https://www.belolaw.com/medical-license-defense-lawyers/nurse-license-defense-attorney-tx/) can guide you through any disciplinary proceedings that you may be facing and help you fight to safeguard your license and career. 

**Defining the Scope of Practice **

The Texas Nursing Practice Act (NPA) and BON rules are sufficiently broad to apply to all levels of nurses in all manner of practice settings. However, the NPA strictly defines the limits of the scope of practice. [Tex. Occ. Code §301.002(2)](https://texas.public.law/statutes/tex._occ._code_section_301.002) defines “professional nursing” as “the performance of an act that requires substantial specialized judgment and skill, the proper performance of which is based on knowledge and application of the principles of biological, physical, and social science as acquired by a completed course in an approved school of professional nursing. The term does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures.” 

Professional nursing involves:

- The observation, assessment, intervention, evaluation, rehabilitation, care and counsel, or health teachings of a person who is ill, injured, infirm, or experiencing a change in normal health processes;
- The maintenance of health or prevention of illness;
- The administration of a medication or treatment as ordered by a physician, podiatrist, or dentist;
- The supervision or teaching of nursing;
- The administration, supervision, and evaluation of nursing practices, policies, and procedures;
- The requesting, receiving, signing for, and distribution of prescription drug samples to patients at practices at which an advanced practice registered nurse is authorized to sign prescription drug orders;
- The performance of an act delegated by a physician under certain sections of the NPA; and
- The development of the nursing care plan.

[Tex. Occ. Code §301.002(5)](https://texas.public.law/statutes/tex._occ._code_section_301.002) provides a similar definition for “vocational nursing.” 

**The Scope of Practice Decision-Making Model**

Since nurses have varying levels of training, knowledge, and competence, each nurse must use their judgment to determine whether they should perform a particular procedure or action. BON recommends that nurses use its [Scope of Practice Decision-Making Model (DMM)](https://www.bon.texas.gov/pdfs/publication_pdfs/Scope%20of%20Practice%20Decision-Making%20Model%20-%20DMM.pdf) to determine whether a procedure or action is within that nurse’s scope of practice. Based on background and experience, two nurses could utilize the DMM to reach different results concerning a procedure or action.

Under the DMM, a nurse should not perform any procedure or action without sufficient education, knowledge, competency, or skill to carry it out safely. Other reasons to refrain from a procedure or action include the lack of an appropriate order, insufficient resources to stabilize the patient, or inadequate supervision. 

To use the DMM, the nurse should first define the activity, task, or procedure at issue. The nurse then must apply the questions outlined in the DMM in the order presented to determine whether to proceed with the action. If the answer to all eight questions is affirmative, the action is within the nurse’s scope of practice. 

The DMM also provides extensive considerations and citations to laws and rules to guide nurses in answering each question. 

**What is a valid order that authorizes the actions of a nurse under the DMM?**

According to the DMM, nurses must act on orders written by practitioners who are legally authorized to prescribe medications and/or treatments in the state. Furthermore, nurses must seek clarification if they have any questions about the appropriateness or accuracy of an order.

**How can a nurse document evidence of current competence to perform certain activities or procedures as per the DMM?**

The DMM commentary states that nurses can acquire education through nursing education programs, continuing nursing education, and/or national nursing certification. Nurses should maintain detailed records of their past experiences with activities, including performance, observation, evaluation, and education provided to others. Additionally, nurses should maintain copies of performance evaluations, skill check-offs, and competency forms. All these types of evidence can serve to support a nurse’s practice decision. 

**What level of supervision is necessary for a licensed vocational nurse (LVN) in terms of the DMM?**

Tex. Occ. Code §301.353 & Board Rule §217.11(2) requires that LVNs have a directed scope of practice that requires supervision by one of the following: a registered nurse, advanced practice registered nurse, physician assistant, physician, podiatrist, or dentist.

### **Get Legal Advice and Protect Your Nursing License **

A [Bertolino LLP nursing license defense lawyer](https://www.belolaw.com/medical-license-defense-lawyers/nurse-license-defense-attorney-tx/) can review your case and help you determine the best strategy to oppose the allegations against you. We can work to protect your license and minimize the adverse consequences of your disciplinary complaint. Call us today at (512) 515-9518 or get more information about us [online](https://www.belolaw.com/contact-us/).

Call or text [(512) 515-9518](tel:+15125159518) or complete a [Case Evaluation form](/case-evaluation/)

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