McDonald, Mackay and White, LLP

The Texas Board of Nursing

Most nurses only think about the Texas Board of Nursing (formally the Texas State Board of Nurse Examiners) [“the Board”] when they are undergoing the process of obtaining their Texas nursing license or when they are renewing the license; however, the Board is involved with more than just the licensing of nurses.  The Board has been charged by the Texas Legislature with the regulation of nursing and the accreditation of nursing schools. In addition, the mission statement of the Board is to protect the public by ensuring that every licensed registered nurse in Texas is able to safely practice as a nurse.

While the act of nursing has been around for centuries, the first nursing laws were not enacted until 1903 in the United States. These acts were developed in response to the organization of physicians in the late 1800’s and the subsequent conflict between physician roles and nursing roles. With the advent of these nurse practice acts, nurses were restricted to nursing functions and any independent functions, which nurses may have previously performed, were restricted. Since that time, the role of the nurse has expanded to reflect the increase in the ability, training, and education of nurses.

The Nurse Practice Acts are enacted by each state’s legislature and the practice acts are called statutory law. The executive branch of the government enforces the nurse practice acts through the state’s regulatory agencies, which is usually that state’s board of nursing. The nurse practice acts are usually broad and non-specific as to the actual practice of nursing; therefore, the regulatory agency issues rules and regulations, which address the specifics of the practice of nursing.

In 1909, Texas enacted the Nurse Practice Act. Currently the function of the Board is to:

  1. "Establish standards of nursing practice and regulate the practice of professional and vocational nursing.
  2. Interpret the Nursing Practice Act and the Rules and Regulations Relating to Nurse Education, Licensure and Practice to nurses, employers, and the public to ensure informed professionals, allied health professionals, and consumers.
  3. Receive complaints and investigate possible violations of the Nursing Practice Act and rules and regulations.
  4. Discipline violators through appropriate legal action to enforce the Nursing Practice Act and rules and regulations.
  5. Provide a mechanism for public comment with regard to the rules and regulations and the Nursing Practice Act and review and modify the rules and regulations when necessary and appropriate.
  6. Examine and license qualified applicants to practice professional and vocational nursing and recognize qualified applicants to practice advanced practice nursing in the state of Texas in a manner that ensures that applicable standards are maintained and that practitioners are minimally competent.
  7. Grant licensure by endorsement to vocational and registered nurses and grant recognition of advanced practice nurses from other states to ensure standards are maintained and applicable practices are consistent.
  8. Recommend to legislature appropriate changes in the Nursing Practice Act to ensure that the act is current and applicable to changing needs and practices.
  9. Establish standards for nursing education and accredit or deny accreditation to schools of nursing and educational programs which fail to meet or maintain the prescribed course of study or other applicable standards to ensure that high levels of education are achieved.
  10. Monitor the examination results of licensure applicants to determine variances in the level of educational effectiveness.
  11. Provide consultation and guidance to nurse education institutions to facilitate self-study, evaluation, and the development of effective nurse education programs.
  12. Provide advice and counsel to the faculty of educational programs, to staff of health agencies utilizing nursing services, and to practitioners of nursing to continually improve professional service delivery.
  13. Implement and manage all other programs and responsibilities as authorized and mandated from time to time by the Texas Legislature." 22 Texas Administrative Code §211.2(b)

“The thirteen members of the Texas Board of Nursing are appointed by the governor with the advice and consent of the senate as follows:

  1. six nurse members, including:
    1. one advanced practice nurse;
    2. two registered nurses who are not advanced practice nurses or members of a nurse faculty;
    3. three vocational nurses who are not members of a nurse faculty;
  2. three members who are nurse faculty members of schools of nursing:
    1. one of whom is a nurse faculty member of a school of nursing offering a baccalaureate degree program in preparing registered nurses;
    2. one of whom is a nurse faculty member of a school of nursing offering an associate degree program in preparing registered nurses;
    3. one of whom is a nurse faculty member of a school of nursing at an institution of higher education preparing vocational nurses;
  3. four members who represent the public."  Texas Nurse Practice Act, Sec. 301.051, Occupations Code.

The entire Board meets every few months and committees of the Board (such as the Eligibility and Disciplinary Committee) may meet more often. Most nurses never interact with the members of the Board. The Executive Director of the Board and the Board staff conducts the day-to-day functioning of the Board and these are the people most nurses will interact with if they contact the Board.

One of the most confusing aspects of the Board for the practicing nurse is the Board’s mission statement. The Board was not established to be the guardian and protector of registered nurses in Texas. This is a surprise to many nurses who often see the Board as an advocate for the registered nurse in Texas. However, the job of advocating for nurses is done by professional organizations such as Texas Nurses Association. The Board’s mission is to protect the public. This is accomplished by licensing only those applicants that can meet the requirements for licensure, by investigating complaints against a registered nurse, and by imposing discipline action on those nurses who have violated the Nursing Practice Act or the Board’s Rules and Regulations.