Effective May 2, 2007, the Texas Board of Nurse Examiners (recently renamed to the Texas Board of Nursing) adopted new language regarding rules §§ 214 and 215 governing Professional and Vocational Nursing Education. First published in the Texas Register on March 9, 2007, the rule change was designed to eliminate any misunderstanding as to the necessary student-to-faculty ratio required for an approved nursing school. The rule makes clear that by using preceptors, the maximum student-to-faculty ratio can be increased to 1:24 and for teaching assistants with a faculty member in a clinical setting, a ratio of 1:15.
More recently on June 22, 2007, the Board adopted numerous changes regarding Continuing Education requirements. Rule § 216 was modified so that a contact hour for continuing education requirements purposes was extended from 50 to 60 minutes. The Rule was also changed such that it is no longer mandatory for RNs to take a CE course on Hepatitis C.
More significantly, the Board has changed its policy on auditing and investigating nurses for compliance with CE requirements. Previously Board rules provided for a random audit of licensees for fulfillment of CE provisions. If no evidence of compliance was provided by the nurse an investigation was initiated which could lead to possible disciplinary action. Under the rule change, all licensees are required to submit evidence of CE compliance when seeking license renewal and if insufficient proof is provided the Board will simply deny their renewal application. This new rule is found at § 216.11.
In March, the Board adopted several amendments to §§ 213.28 and 213.33, two rules related to practice and procedure in disciplinary matters. Language was added to § 213.33 outlining the specific qualifications required of a Board appointed psychologist or psychiatrist who is charged with evaluating a licensee’s present fitness to practice nursing (§ 213.33(e)). The new provisions also permit the Board to request that the licensee be examined by a forensic psychologist or psychiatrist to determine the likelihood of future violations by the nurse and the level of danger they pose to the public (§ 213.33(f)).
Rule § 213.28 pertaining to the licensure of persons with criminal convictions has received significant additions to what the Board considers to be a crime related to and affecting the practice of nursing. The new language expressly provides that the following types of offenses are now deemed to relate to the practice of nursing: 1) offenses against the person similar to those outlined in Title 5 of the Penal Code; 2) offenses against property including robbery, theft, and burglary; 3) offenses involving fraud and deception; 4) offenses involving lying and falsification; and 5) offenses involving the delivery, possession, manufacture, or use of, or dispensing or prescribing a controlled substance, dangerous drug, or mood-altering substance (§ 213.28(b)). Note that the modified rule retains all of its old contents; Subsection (d) has simply been inserted into the middle of the rule.
During the comment period for this rule, one party raised the objection that this new list of crimes held to relate to the practice of nursing merely piles another vague standard on top of the already amorphous rules on what constitutes unprofessional conduct. This amendment to § 213.28 simply provides another readily malleable means for the Nursing Board to discipline nurses for conduct over which they have no original jurisdiction by simply stating that it “relates to the practice of nursing.” The Board dismissed this valid criticism with the comment that it was authorized under the Nursing Practice Act to adopt such a rule and that other state licensing agencies have similar rules. Of course the obvious response to this argument is that other Board’s who have similarly vague rules on unprofessional conduct are vulnerable to precisely the same criticism and should also adopt clearer and more reasonable rules on what actually relates to the practice of their particular professional. No licensing Board should respond to public pressure to go after “bad” professionals by crafting an all-encompassing standard on what constitutes grounds for disciplinary action. This policy results in numerous nurses being subject to the high personal and financial costs of an investigation and disciplinary action who have engaged in what may perhaps be regrettable conduct that was, however, completely outside of their work and professional environment. In the long term such a stance can only erode the trust of both the public and Texas nurses with the Texas Board of Nursing