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FAQs Relating to Nursing Practice in Disaster Areas

Texas medical defense attorneyAfter Hurricane Harvey made landfall last August, nurses were called upon to help with injuries and disaster preparedness. Indeed, nurses from Texas and all over the country showed up to provide emergency medical services to people in need.

The Texas Board of Nursing (BON) called upon out-of-state nurses to come help in the disaster areas. Ultimately, the Board issued over 600 temporary licenses to out-of-state nurses. And many more nurses holding a multi-state license under the Nurse License Compact showed up to render aid.

Unfortunately, our reality is that disasters are going to occur, and we need to be prepared to mobilize our forces to respond when they do.

FAQs Relating to Nursing Practice in Disaster Areas

The following pertain specifically to nurses licensed by the Texas Board of Nursing. Note that Texas is a member state of the Enhanced Nursing Licensure Compact (eNLC).

  1. During a disaster, do I still need physician orders to provide medications to patients?

The Nursing Practice Act (NPA) prohibits nurses from "acts of medical diagnosis or the prescription of therapeutic or corrective measures." NPA § 301.002(2)&(5). Even in times of a disaster, Texas nurses are required to adhere to the Board's rules and the NPA.

Please reference the BON's Position Statement 15.5 for guidance on nurses' responsibility for initiating physician standing orders, which are written instructions prepared by a physician for a patient population with specific diseases, health problems, or set of symptoms.

  1. Is there an expansion to the registered nurse (RN) or licensed vocational nurse (LVN) scope of practice when practicing nursing in a disaster?

No, the RN and LVN scope of practice remains unchanged in a disaster. The practice of nursing requires the procedures being performed be within the scope of the nurses’ practice. Further, appropriate Standing Orders must be in place for acts that may go beyond the practice of nursing.

  1. Is there an expansion to the advanced practice registered nurse (APRN) scope of practice when practicing nursing in a disaster?

No, the APRN scope of practice remains unchanged in a disaster. APRN's are required to practice in the role and population focus area for which they were educated and licensed by the BON.

An APRN who does not yet have the proper prescriptive authority agreements in place and is providing health care services as part of disaster relief efforts may obtain prescriptive authority, but "must establish a verbal agreement for delegated authority to provide medical aspects of care and prescriptive authority with a physician at the site where they are providing emergency care services while the waiver of certain Board Rules by the Office of the Governor is in effect and during the period the disaster declaration is in effect."

  1. Can a Texas nurse be required to work overtime during a disaster?

Yes. While the Health and Safety Code, Chapter 258 prohibits mandatory overtime for nurses, an emergency, disaster, or unforeseen event constitutes an exception to this prohibition.

It is important to understand that at all times, regardless of practice setting, Texas nurses are required to adhere to the NPA and Board Rules.

Professional License Defense Attorneys

BERTOLINO LLP represents licensed professionals across the entire State of Texas. If you are facing disciplinary action from the Texas Board of Nursing or any medical or professional licensing board, contact us today or call (800) 210-0126 and schedule a case evaluation.

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Attorney Tony R. Bertolino is the Managing Partner with Bertolino LLP. Our law firm has been able to help people across the state of Texas. If you need an experienced lawyer to represent you, contact Bertolino LLP today.

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