Anticipating the Future Maintaining Your License

1
Anticipating the FutureMaintaining Your License

• By
• Charlene Morris, RN, MSN

2
Texas Occupations Code

• Governs many occupations
• Chapter 301 - Law that establishes empowers
• Board of Nursing for the State
• of Texas
• Contains the Nurse Practice Act
• Contains law setting up rules and regulations for
  nursing practice in Texas Defines the SCOPE of
  PRACTICE
• Texas Administrative Code
• Provides more detail on how the requirements of
  the Occupations Code are to be carried out.
• Appointment of members, meetings, proceedings,
  investigations, disciplinary actions, etc.

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Texas Occupations Code

• Chapter 301 Nursing Practice Act
• Chapter 303 Nursing Peer Review
• Chapter 304 Nurse Licensure Compact
• Chapter 305 Advanced Practice Registered Nurse
  Licensure Compact

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• Texas Administrative Code
• TITLE 22 EXAMINING BOARDS
• PART 11 BOARD OF NURSING
• CHAPTER 211 GENERAL PROVISIONS
• RULE 211.1 Introduction
• Name. Texas Board of Nursing
• Decision-making board appointed by the
  Governor
• (Texas Occupations Code).
• (b) Location. Austin, Texas
• (c) Legal Authority. Chapters 301, 303, 304. and
  305 - Texas Occupations Code.
• (d) Composition. Persons appointed by the
  Governor with Senate approval.
• (Source Note The provisions of this 211.1
  adopted to be effective March 31, 2002, 27 TexReg
  2236 amended to be effective May 17, 2004, 29
  TexReg 4884

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Texas Administrative Code GENERAL PROVISIONS RULE
211.3 Organization and Structure ( (b) Terms of
office for Board members. Six years in length
with staggered terms. Members may be reappointed
by the Governor. (c) Eligibility. Board member
eligibility is governed by the Texas Occupations
Code 301.052 and 301.053. (d) Compensation.
Per diem as provided by law for each day that
the member engages in the business of the board
Travel expenses Source Note The provisions of
this 211.3 adopted to be effective March 31,
2002, 27 TexReg 2236 amended to be effective May
17, 2004, 29 TexReg 4884
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TEXAS OCCUPATIONS CODE AND STATUTES REGULATING
THE  PRACTICE OF NURSING AGENCY MISSION The
mission of the Texas Board of Nursing (BON) is to
protect and promote the welfare of the people of
Texas by ensuring that each person holding a
license as a nurse in the State of Texas is
competent to practice safely. This mission,
derived from the Nursing Practice Act, supersedes
the interest of any individual, the nursing
profession, or any special interest group.
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Protecting the People of Texas
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Texas Administrative Code BOARD OF
NURSING Purpose and Functions Purpose. The
board fulfills its mission through two principle
areas of responsibility   (1) regulation of
the practice of professional and vocational
nursing   (2) accreditation of schools of
nursing.
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Texas Administrative Code - Functions of BOARD OF
NURSING The board shall perform the following
functions as outlined in Texas Occupations Code
chapters 301, 303, 304, 305.   (1) Establish
standards and regulate the practice of
professional and vocational nursing.   (2)
Interpret the Nursing Practice Act and
Regulations Relating to Nurse Education
Licensure and Practice of nurses Employers
Public to ensure informed professionals,
allied health professionals, and consumers.   
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Texas Administrative Code - Functions of BOARD OF
NURSING The board shall perform the following
functions as outlined in Texas Occupations Code
chapters 301, 303, 304, 305.     (3) Receive
complaints and investigate possible violations.
   (4) Discipline violators through
appropriate legal action.   (5) Provide a
mechanism for public comment and by which the
rules and regulations are modified when
appropriate.   
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(6) Examine and license qualified applicants and
recognize qualified applicants for advanced
practice nursing as minimally competent.   (7)
Grant licensure by endorsement and grant
recognition of advanced practice nurses from
other states.   (8) Recommend to legislature
appropriate changes in the Nursing Practice Act
   (9) Establish standards for nursing
education and accredit or deny accreditation of
schools.   
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   (10) Monitor the examination results of
applicants for variances in the level of
educational effectiveness.   (11) Consultation
and guidance to nurse schools for self-study,
evaluation, and the development of effective
education programs.   (12) Provide advice to
the faculty, staff of health care agencies
utilizing nursing services, and practitioners of
nursing to improve professional service.   (13)
Implement and manage all other programs and
responsibilities as authorized and mandated by
the Texas Legislature. Source Note The
provisions of this 211.2 adopted to be effective
March 31, 2002, 27 TexReg 2236 amended to be
effective May 17, 2004, 29 TexReg 4884
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Standards of Nursing Practice in the state of
Texas
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Texas Administrative Code Chapter 217 Rule
217.11-Standards of Nursing Practice in the
state of Texas

• Know and conform to Nurse Practice Act Rules
• Promote safe environment
• Know rationale effects of meds treatments
• Administer them safely, stabilize pts. and
  question orders PRN
• Accurately document/report assessments and
  response to care and pt. status as well as
  contacts with other health care team members
• Respect patients right to privacy
  confidentiality
• Provide education/counseling to client, family,
  etc. referrals

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Texas Administrative Code Chapter 217 Rule
217.11-Standards of Nursing Practice in the
state of Texas cont.

• Obtain appropriate supervision, orientation,
  in-service info, CEs
• Accept responsibility for competence growth
• Notify supervisor when leaving nursing assignment
• Maintain professional boundaries
• Comply with reporting requirements
• Provide care without discrimination within own
  abilities and those of others you are supervising
• Implement measures to stabilize clients and
  prevent complications
• Implement measures to prevent exposure to
  infectious disease

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Texas Administrative Code Chapter 217 Rule
217.11-Standards of Nursing Practice in the
state of Texas cont.

• Clarify any order or treatment that may be
  inaccurate, non-efficacious or contraindicated by
  consulting the appropriate licensed practitioner
  and notifying the ordering practitioner when
  deciding not to administer the medication or
  treatment
• Collaborate with the client, care team, and when
  appropriate the clients family to provide
  optimal care.
• Make appropriate referrals for continuity of
  care.

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Texas Administrative Code Chapter 217 Rule
217.11-Standards of Nursing Practice in the
state of Texas cont.

• Make appropriate/safe assignments based on
  ability and clients needs
• Accept only those assignments that you can do
  safely.
• Supervise those for whom they are responsible.
• Ensure verification of current licensure or
  compact privilege when administratively
  responsible

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Texas Administrative Code Chapter 217 Rule
217.11-Standards of Nursing Practice in the
state of Texas just for RNs.

• Use systematic approach to provide
  individualized, goal directed nursing care based
  on nursing process.
• Delegate tasks to unlicensed personnel in
  compliance with Chapter 224 (acute care settings)
  and Chapter 225 (independent living environments)
  with stable and predictable conditions.

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Contacting the Texas Board of Nursing Location of
Boards office 333 Guadalupe, 3-460 Austin,
Texas 78701 Telephone [phone]Web
page http//www.bon.state.tx.us/contact/
Contact Person Katherine Thomas, MN, RN,
Executive Director
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Texas Licensure
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Assuring Competence

• NCLEX-RN assures knowledge base
  decision-making ability
• Graduation from accredited school
• Psychomotor/technical skill safety
• Legal/ethical knowledge values
• Interpersonal skills
• Decision-making skills
• Basis for schools evaluation criteria from BON
  Rules Regulations
• Standards of Nursing Practice in Texas
• Unprofessional Conduct

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Applying for your License

• See the http//www.ncsbn.org/ and
• www.pearsonvue.com/nclex web sites
• See check list at end of application
• BON Application
• finger prints photo
• BON application with fee
• Registration for NCLEX-RN Exam
• NCLEX-RN Examination application form
• Pay NCLEX Registration fee
• Affidavit of Graduation from Nursing Program

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2010 New NCLEX Test Plan

• Percentage of Items from Each Client Needs
  Category/Subcategory
• Safe and Effective Care Environment
• ..Management of Care 16-22
• ..Safety and Infection Control 8-14
• Heath Promotion and Maintenance 6-12
• Psychosocial Integrity 6-12
• Physiological Integrity
• ..Basic Care and Comfort 6-12
• ..Pharmacological and Parenteral Therapies 13-19
• ..Reduction of Risk Potential 10-16
• ..Physiological Adaptation 11-17

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Test Plan cont.

• Variety of test items are not limited to
• multiple choice, multiple response,
  fill-in-the-blank calculation, drag and drop,
  and/or hot spots.
• all item types may include multimedia, such as
  charts, tables, graphics, sound and video.
• For more information, visit the NCSBN Web site at
  www.ncsbn.org to review Information about
  Alternate Item Formats.
• Some questions will apply knowledge from 2
  different categories

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Type of Testing

• CAT Computer Adaptive Testing
• Identifies 95 chance of safe practice
• Various types of questions
• Pictures, fill in the blank, multiple answer,
  etc.
• Dont make wild guesses to finish items
• Each test is different
• Computer selects items for candidates skill
  level
• Level of question based on answer to previous
  question
• Different questions each time applicant tests
• Contains some items that are not graded
• Instructions, sample items, and breaks are
  included in testing time period allowed

www.pearsonvue.com/nclex
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NCLEX-RN Success

• Web sites
• HESI exam as predictor danger lt 850
• Review course or review books
• Level 4 exam scores predictor of specific areas

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Test Taking Tips

• Study practice (1 question per 60 to 70
  seconds)
• Plan
• Austin testing sites
• Pearson Professional Centers-Austin, TX
• 301 Congress Avenue Suite 565
• Austin,Texas78701
• 512-469-0276
• Schedule carefully
• Sleep, eat, take precautions to promote calm
• Strengthen testing strategies
• Read carefully (1 to 2 min./item)
• Think through but dont read into question
• Remember entry level for LVN and/or CNA or UAP
• Text book not the patient you saw in clinical
• Use your breaks to rest

www.pearsonvue.com/nclex
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What to Expect/Prepare

• Arrive 30 minutes early, if you are more than 30
  min. late for testing, you will need to be
  rescheduled and pay fee again
• Come alone no children/family/friends waiting or
  calling
• No hats, scarves, coats, calculators, pencils,
  etc. permitted in testing area
• Bring
• Authorization to Test (ATT) form needed to
  schedule testing session Name same as on ID
• Valid non-expired Photo ID with your signature
• Finger print, Palm print, photo, signature will
  be taken on admission to test and after breaks

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What to Expect/Prepare

• May take up to 6 hours to complete test - raise
  hand dont get up
• First optional break after 2 hrs. palm vein
  imaging before and after breaks
• Second is 90 minutes after test resumes
• Must use computer calculator
• 75 to 265 questions 15 unscored
• Number of questions does not predict Pass/Fail
• 75 high pass or fail as computer determines
  trends
• Must answer each item to continue the test after
  (ENTER), cant go back

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What to Expect/Prepare

• Official results come from BON- up to 14 days
  after BON receives scores
• You can also get your unofficial results after
  48 business hours through the quick results
• service available on the NCLEX Candidate Web site
  (7.95), or by calling 1-900-776-2539 (9.95)..
• Retest every 45/90 days for 4 years in Texas
• Sec. 301.255 Re-examination. (Texas Occupations
  Code- BON may require additional educational
  requirements or deny retesting if test is failed
  2 or more times.)

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Jurisprudence Exam

• You must take the exam and pass it once to become
  an RN.
• Cost of exam will be part of application fee and
  will be taken on your computer from the BON
  website.
• You may take it as many times as you need to for
  a passing score q 7 days.

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Exam cont.

• You will know if you passed upon completion 75
  is a passing score.
• It will be open book from the NPA and it will be
  timed 2 hours.
• 50 Questions and will be knowledge and
  application. (Will not ask for specific section
  numbers of Nurse Practice Act but will test for
  understanding)

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Test Blueprint

• 5 subject areas with weight
• A. Nursing Licensure Regulation in Texas 15
• B. Nursing Ethics 20
• C. Nursing Practice - 30
• D. Nursing Peer Review- 15
• E. Disciplinary Action 20
  Topic areas to
  guide review of content are available on the BON
  website.

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Test Review

•         BON has developed an online Test
  Review/Prep Workshop which costs about 25 and
  takes about 2 hours to complete.
•         This course is accessed on the BON
  website after applying and obtaining a pin number
  from the BON.

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Guidelines for New Graduates New RNs

• What are the requirements that must be met to
  obtain a GN Verification Letter?
• Once granted, what are the limitations of
  practice placed on a GN using this privilege?
• Compare these limitations to those that the BON
  recommends for newly licensed RNs.

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Guidelines for New Graduates Employment

• GN verification letter issued after
• Completion of application for licensure
• Criminal checks complete
• Affidavit of graduation
• Received your Authorization to Test
• Registered with Pearson
• NCLEX testing date set
• No outstanding eligibility issues
• 75 day period specified on GN Verification letter
  or results of first NCLEX attempt
• If first NCLEX is failed MUST stop GN practice
• Must know and follow Nurse Practice Act Rules
  and Regulations

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Graduate Nurse Requirements

• Temporary Authorization to Practice
• Must work under direct supervision of RN
• RN physically available
• RN at same site
• May not be in charge or supervising
• May not function in an independent setting
• May perform any function that falls within the
  scope of practice for which they have educational
  preparation and demonstrated minimal competency

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BON Rule 217.3 Recommendations After Licensure

• These are for your protection
• Direct supervision for 6 months or less if agreed
  upon by new graduate and supervising RN
• Competence agreed upon by both
• Successful completion of orientation requirements
• Newly licensed should not be in charge for 6
  months unless agreed upon by grad RN

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Newly Licensed Nurse

• Guideline
• Amount of supervision and charge positions should
  be mutually agreed upon
• 12-18 months experience in a structured setting
  before practicing in independent living
  environment

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Continuing Competency

• Identify how competency is maintained and
  validated.
• How are CEs approved?
• What type of learning experiences can be counted
  as CE credit toward license renewal? What
  learning experiences are not acceptable?
• Describe required record keeping related to CEs.

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Continuing Competency (Sec. 301.303 Occupations
Code

• Completion of targeted cont. ed. programs
• Professional portfolio including certifications
• May not require more than 20 hours CE per 2 year
  period
• Specific State Requirements
• Hepatitis C between June 2002 June 2004
• Bioterrorism Response was a one time requirement
• Forensic Evidence Collection 2 hrs. for ER
  nurses by Sept. 1, 2008

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Texas Administrative Code (216.1) - 2005

• All CEs To count toward licensure renewal, a
  program must have been approved by one of the
  credentialing agencies recognized by the Board.
  The credentialing agencies have met
  nationally-predetermined criteria to approve
  programs and providers of CE.
• RN planner
• Approved by accepted credentialing agency
• Class or individualized home study/programmed
  instruction
• One CE hour 60 minutes not 50 as in the past
• A 3hr. academic nursing course (part of a degree
  plan taken for credit with grade C or better or a
  pass of pass/fail) counts for 15 hours
• ACLS, ATLS, and PALS, or national certification
  in a non-advanced nursing practice specialty
  (i.e. CCRN, RNFA, CWOCN, etc.) may be counted for
  CE credit
• In-services, CPR, Refresher courses do not count.
• Keep records for 4 years

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License Renewal

• Describe the license renewal process for new RNs
  and experienced RNs. What criteria must be met
  for standard renewal?
• What are the requirements for reactivation when
  the license was in an official inactive status
  for more than 4 years?
• What are the requirements for licensure for
  retired RNs who volunteer their service at a
  community agency?

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Texas Administrative Code (216.1) - 2005

• License Renewal every 2 years - 65
• End of Birth month and odd or even years based on
  birth year
• Receive post card reminder 30 days prior
• (90 days if CE audit required)
• Renew on line at BON web site credit/debit card
  if meet all criteria
• No bars delinquent student loans/child support,
  legal issues, Psych illness, drugs, and lack of
  required CEs
• Application implies legal signature/testimony of
  meeting criteria and makes nurse legally
  responsible for accuracy.
• First renewal
• Continuing education required not need 20 hours
• ER Forensic Evidence Collection 2 hours
• Six to 29 months after first issued depending on
  nurses date of birth.

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Nursing Licensure Compact

• States participating in a Licensure Compact
  accept similar requirements for licensure. What
  is a nurses Home State and how does that relate
  to licensure?
• When a nurse practices in a party state whose
  laws and scope of practice guide the care
  provided by the nurse?
• Can the nurse simultaneously hold a home state
  license in more than one party state? Under what
  circumstance can the nurse hold a license in more
  than one state at the same time?

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Nursing Licensure Compact

• Chapter 304
• Rule 220

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Nurse Licensure Compact

• States agreeing to recognize each others nursing
  licenses
• Texas among the first to adopt this plan - 2000
• Premise
• Only defines the requirements to hold a license
• Similar licensure requirements in most states
• Each state defines its own scope of practice
• States share information related to problems
• Warnings
• Suspensions
• Licenses that have been revoked
• Imposters

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Map indicates which states that have enacted the
RN and LPN/VN Nurse Licensure Compact  
Updated 2010
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Compact Definitions

• Party States
• States who have adopted the compact
• Primary state of residence (Home state)
• Where you permanently reside or your declared
  fixed permanent principal home for legal
  purposes
• Remote state
• Where you practice using multistate privilege
• Must be a party state

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Compact Requirements

• Nurse must
• Maintain home state license
• Adhere to practice laws of state in which the
  patient is located at time of care
• Use multi state privilege only in party states
• Hold a home state license in only one party state
  at a time
• If permanent home address changes to another
  party state, relinquishes license of previous
  state
• Applies for meets requirements for licensure in
  new Home state (30 day grace period for
  processing new license)

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Practicing in a Different State

• How is a nurses licensure impacted when he/she
  changes their permanent address from one state to
  another? Differentiate between movement from one
  party state to another as opposed to movement
  from a party state to a non-party (remote) state?
  
• Can a nurse hold permanent residence on a party
  state and work in a remote state?
• What are the requirements and limitations of a
  nurse licensed in a remote state when they wish
  to obtain a license to practice in Texas?

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Practicing in a Non-Party State

• Must obtain a license from the non-party state
• May hold both a home state license and a license
  from the non-party state
• If you live in a non-party state
• Must obtain a non-resident Texas license to
  practice in Texas
• Lose multistate licensure privilege in other
  party states

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Impact of Licensure Compact

• States share information
• Nurses licensed
• Disciplinary action
• Protects public health and safety
• More mobile workforce for employers
• Allows nurses to be more mobile
• Provides for new forms of practice
• Online practice
• Telephone practice

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Peer Review
Incident-Based Peer Review Rule 217.19 And Safe
Harbor Peer Review Rule 217.20
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Determine Scope of Practice

• The Six Step Decision Making Model found in the
  back of Nursing Practice Act, Nursing Peer
  Review, Nurse Licensure Compact

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Rule 217.11 and 217.12

• Rule 217.11 Standards of Practice
• and 217.12 Unprofessional Conduct
• Provide baseline for safe and effective care
• Establish minimal acceptable level
• Identifies unprofessional behaviors

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Unprofessional Conduct Peer Review

• Discus unprofessional conduct.
• Describe the types of agencies that must have a
  Peer Review Committee. Describe an incident based
  peer review process.
• Are the findings always reported to the BON? What
  must be reported? How is it reported?

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Incident-Based Nursing Peer Review

• Evaluation of
• Nursing services
• Qualifications of a nurse
• Quality of care provided
• The merits of a complaint about a nurse
• Recommendations about a complaint
• Nurse under review given written notice to attend
  with info about complaint
• Fact finding process, analysis studying events
  that occurred - due process as right to question
  witnesses and confidentiality
• Climate of collegial problem solving
• Not a legal proceeding but can have lawyer/peer
• If fault is found nurse is subject to Reporting
  Requirements

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Peer Review RNs LVNs

• Employers of 10 or more licensed nurses must have
  a Peer Review Committee
• Putting a patient or other person at risk of
  unnecessary harm
• Failure to adequately care for a patient
• Unprofessional conduct (217.12)
• Failure to conform to minimum standards of
  practice (217.11)
• Impairment or likely impairment of the nurses
  practice due to chemical dependency

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The Nurses Duty to Report

• Licensed care giver, agency, or facility
• Exposing a patient to substantial risk of harm
  due to
• lack of minimum standard of nursing care
• Another nurse
• Impairment, lack of minimum standard of care,
  unprofessional conduct, or unnecessary exposure
  of pt. to risk for harm
• Nursing student
• Chemical impairment
• Ability to perform professional service within
  reasonable expectations

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Reporting (for Peer Review or BON)

• Must be in writing and signed
• Must include name of nurse or student and
  information required by the Board
• May take the report to the employer or school

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Action Peer Review Committee/BON

• Problem reported to employer
• Proceedings are confidential
• If committee finds cause they must report to BON
• Identity
• Problem
• Corrective action taken
• Recommendation for BON action

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Minor Incidents - Rule 217.16

• Describe a minor incident.
• When and how are they reported and to whom?
• What are the consequences of frequent minor
  incidents?
• What types of incidents are considered major?

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Minor Incidents Rule 217.16

• Continued practice doesnt pose risk of harm to
  client(s)
• Potential risk of harm is very low
• Incident is singular
• Nurses approach to practice is conscientious and
  accountable
• Has knowledge and skill for safe practice
• 5 minor incidents in any consecutive 12 month
  period must be reported to Peer Review Committee
• If no Peer Review Committee is available must
  report to BON

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Conduct Assistance

• What is unprofessional conduct? Provide examples
  of this type of problem.
• What types of problems fall under 217.13? What
  types of assistance is available to nurses who
  have these types of problems?
• What can happen to their license if they can not
  comply with professional conduct or restrictions
  of supervision?

66
217.12 Unprofessional Conduct

• Purpose
• Protect the public from
• Incompetent careless
• Unethical
• Illegal conduct of nurses
• Applies to any licensed nurse

67
Peer Assistance Rule 217.13

• Required by law
• Identifies, assists, and monitors professional
  colleagues so they can work
• Experiencing mental health, alcohol or drug
  problems
• Problems impair or may impair job performance or
  safe care

68
Safe Harbor Peer Review
69
Safe Harbor Peer Review

• Protects nurses asked to engage in conduct which
  they believe violates duty to patient
• Duty to Patient means conduct including
  administrative decisions directly affecting a
  nurses ability to comply with that duty required
  by
• Standards of practice Best Practices
  originate from Evidence Based Research
• Professional conduct adopted by the Board in
  Section 303.005 (a)
• Required by facilities employing/contracting at
  least 10 nurses

70
Safe Harbor Peer Review/Protection

• Describe how Safe Harbor Peer Review differs from
  Incident Based Peer Review.
• What is duty to patient? How is the nurse who
  invokes Safe Harbor protected? When Safe Harbor
  is invoked, how is the nurses accountability for
  safe patient care impacted?
• How does a nurse invoke Safe Harbor? Describe the
  Safe Harbor Peer review process.

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Safe Harbor Peer Review Protection

• Nurse may not be disciplined or discriminated
  against for making the request
• May engage in requested conduct pending the peer
  review
• Is not subject to the reporting requirement just
  presented
• May not be disciplined by BON for engaging in
  conduct while review is pending

72
Requesting Safe Harbor

• Must be done in good faith
• Must notify supervisor making the assignment that
  he/she is invoking safe harbor
• Use form on BON web site
• Or include all info. on required form
• If used to question a medical order
• Medical staff/director will make a determination
• Nurse invoking Safe Harbor will get a copy of
  Peer Review Committees determination and the
  administrators review

73
Entry into Practice Issues

• 1965 ANA paper recommended BSN
• 50 years of debate
• Same licensing exam
• 2000 ANA reaffirmed its recommendation
• Public Health Nursing usually requires BSN
• Specialist positions may require MSN
• Certification

74
Differentiated Practice

• Structured nursing roles based on
• Education
• Experience
• Competence
• Education based different prep different
  roles
• Assessment based all facets, competency focused

75
Differentiated Practice Models

• 20 years of studies
• Roles and compensation level delineated according
  to education level not widely used
• Basis of competency models
• ANAs standards of care with levels of practice
• Novice to expert (RN 1 to RN 4)
• Can be based on job description and evaluation

76
Questions to ASK at Interviews

• How are competencies attained, maintained, and
  measured?
• Orientation or internships available
• Provision for continuing education
• Regular skill updates or reviews competency
  evaluation
• Career ladder, levels of practice, promotion, or
  specialization with compensation
• Your job description
• Criteria by which you will be evaluated

77
Regulatory Agencies

• BON
• Certification- government standards
• Accreditation - non-government standards
• Medicare/Medicaid federal standards
• Accreditation non - government
• JCAHO (Now known as TJC or The Joint Commission)
  - hospitals
• CHAP Community Health Accreditation Program

78
Advisory Groups

• Secretary of Health, Congress National Advisory
  Council on Nurse Education and Practice
• Workforce diversity
• Cultural competency
• Nursing shortage
• JCAHO Nursing Advisory Council

79
Examples of Texas Legislation

• Nursing shortage
• Hepatitis C Bioterrorism continuing education
  requirements

80
Texas Nurses Association

• Mission Promote excellence through leadership,
  advocacy, and innovation
• Advocate for nursing in the legislature
• Continuing education
• Updates on legal issues and legislation
• Interpretation of legal BON changes
• www.texasnurses.org

81
American Nurses Association

• Advocates for Nursing Profession
• Defines ethical standards of practice for
  Profession
• General RN
• Specialty areas
• Provides avenue for nursing to be involved in
  national level of decision making
• AJN

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The End