NPA §301.306 and Rule 216.3(5) - January 2006
(1) Question: Could the BON require more than just two (2) hours of CE? (Suggest maybe 2 hours the first year, an additional 2 hours the second year, etc).
Response: Given the multitude of practice settings and procedures nurses may perform, requiring prescriptive training requirements for every task or procedure a nurse may be able to perform would be a never-ending task. Proposed Rule language [22 Texas Administrative Code §216.3(5)] mirror-images the language in the statute (Texas Occupations Code §301.306). Both the statute and the rule mandate a minimum of two hours of continuing education in forensic evidence collection. A facility is not precluded from establishing more stringent CE requirements if it so chooses. The BON has no jurisdiction over facilities.
The Board holds each licensed nurse accountable to comply with the Nursing Practice Act [Texas Occupations Code Chapters 301, 303, & 304] as well as Board Rules [22 Texas Administrative Code et al.]. In particular, Rule 217.11, Standards of Nursing Practice, sets forth broad requirements for a nurse, regardless of practice setting. This rule requires a nurse to act in the client’s best interest, including:
- (1)(B) "maintain a safe environment for clients and others";
- (1)(G) "obtain instruction and supervision as necessary when implementing nursing procedures or practices";
- (1)(H) "make a reasonable effort to obtain orientation/training for competency when encountering new equipment and technology or unfamiliar care situations";
- (1)(R) "be responsible for one's own continuing competency in nursing practice and individual professional growth"; and
- (1)(T) "accept only those nursing assignments that take into consideration client safety and that are commensurate with the nurse's educational preparation, experience, knowledge, and physical and emotional ability."
(2) Question: There is no explanation of "service-approved evidence collection kit and protocol." Is there a standard for an "evidence collection kit"?
Response: The statutes for evidence collection and documentation are contained in laws outside the jurisdiction of the BON. The terminology "service-approved evidence collection kit and protocol" is taken directly from section 420.031 of the Government Code. The statutes in Chapter 420 may be viewed at the web site for the Texas Statutes, http://tlo2.tlc.state.tx.us/statutes/gv.toc.htm. Though this particular law addresses sexual assault evidence collection specifically, the term itself is generic in nature and intended to encompass evidence collection and documentation standards for any given practice situation relating to forensics, not just sexual assaults.
The Board has long maintained the position that nursing professional organizations and/or regulatory entities that focus on a specialty area of practice are far better resources for determining appropriate standards of care for a given specialty area of nursing. An extensive list of prescriptive documentation requirements would not serve the best interest of protecting the public or communicating current standards of care to nurses in any given specialty area because various types of forensic evidence collection would meet rule requirements and evidence-based practice standards are continually evolving.
(3) Question: The documentation requirements do not list everything that should be documented regarding forensic evidence (such as in a sexual assault case).
Response: The Board has long maintained the position that nursing professional organizations and/or regulatory entities that focus on a specialty area of practice are far better resources for determining appropriate standards of care for a given specialty area of nursing. An extensive list of prescriptive documentation requirements would not serve the best interest of protecting the public or communicating current standards of care to nurses in any given specialty area due to the fact that evidence-based practice standards are in an ongoing state of evolution. Other laws outside of the NPA and rules may also place additional requirements on a facility, thus impacting what information the nurse must record.
For example, in addition to standardized documentation required in the Sexual Assault Prevention and Crisis Services (SAPCS) Protocol, facilities providing sexual assault services to victims must also comply with other laws that involve mandatory documentation of findings and services offered to the victim for legal as well as medical purposes. As the BON has no jurisdiction over facilities, we cannot speak to these requirements; however, the facility may be required to have policies that address specific documentation mandates that impact any nurse involved with sexual assault or other types of forensic examinations. {Also see the Response to FAQ #2.}
(4) Question: Many aspects of forensics exist, and not all are related to sexual assault. The California Board of Nurse Examiners allows their nurses to obtain CEUs related to all types of Forensics. In the Emergency Department, gunshot wounds, motor vehicle accidents, and assaults are classified under forensics. Is the Texas forensic CEU requirement only related to sexual assault evidence collection?
Response: No, proposed Rule 216.3(5) does not limit appropriate CE to only sexual assault evidence collection. Nursing laws can and do vary from state-to-state. The Texas Legislature passes laws (Texas Occupations Code chapters 301, 303, and 304) that establish the requirements for nursing education and practice in Texas. The Board of Nurse Examiners must then create and/or amend rules to implement the statutes as passed by the Legislature each biennial session. This means that what is acceptable in California may or may not be acceptable to meet licensure requirements in Texas.
Proposed rule 216.3(5) specifically addresses requirements in NPA section 301.306, Forensic Evidence Collection Component in Continuing Education. While SB39 [79th Regular Session, Texas Legislature (2005)] did not include language limiting "forensic evidence collection" to only sexual assault victims, a review of the Bill analysis and history demonstrate that this was the original intent of this legislation. The Board believes the generic nature of the final bill language encompasses broader training in forensic evidence collection. Thus, nurses whose practice settings include the ED are encouraged to seek forensic CE offerings that are appropriate for the types of patients seen in the nurse’s clinical practice.
(5) Question: The American Forensic Nurses Association offers an online SANE (Sexual Assault Nurse Examiner) evidence collection course. It is a 4 hour CEU course on Basic Evidence Collection related to what is required when performing sexual assault forensic examinations. Will this meet Texas requirements?
Response: Provided a CE offering covers the topics listed in the proposed Rule 216.3(5)(D), it should meet Texas requirements as either a Type I or Type II CE. For specifics on what qualifies as Type I versus Type II CE, see Rule 216 in its entirety as well as the Board,s CE Brochure titled "The 1-2-3's of CE" on the Board's web page under "Publications."
The Texas BON does not approve CE offerings. We recognize that it may take some time for various organizations to develop 2-hour CE offerings that meet the criteria in the rule, as most current nursing CE related to sexual assault exams is 40-60 hours in length. A nurse working in an emergency room setting has two years to comply with the requirment beginning September 1, 2006. The earliest any nurse could be audited for this CE will be September 2008.
(6) Question: Do we really want someone who "floats" to an Emergency Department (ED) without established/documented duration, frequency, history, competency, etc. collecting this evidence?
Response: The language passed by the Texas Legislature in SB39 states that the forensic continuing education requirement applies to a "license holder who is employed to work in an emergency room..." A review of the bill analysis reveals that the concern of the original bill was that sexual assault victims in rural areas may not receive the same level of care as those in metropolitan areas where SANE-trained RNs are typically available. When evidence is either not collected or collected incorrectly by staff who has no training in forensic evidence collection and documentation, law enforcement authorities may lack the necessary evidence to prosecute criminals who perpetrate crimes against other persons.
While some practice settings may have the luxury of always having a specialty certified RN (such as a SANE nurse) available to perform specific types of forensic evidence collection, there will be settings where this is not the case, and where the nurse who "floats" to the emergency department may be the professional responsible for collecting (or assisting with collection of) evidence. Therefore, even if a nurse floats to the ED on rare occasions and is not required by his/her facility to carry out forensic evidence collection, this nurse would have to meet the forensic CE requirement to comply with the BON rule.
As the Board has no jurisdiction over facilities, the BON has no control over staffing plans, job descriptions, how nurses may or may not be rotated through or floated to the ED, or to establish a minimum number of hours a nurse must work in an ED setting. It would be up to facility or unit policy to determine which nurses will perform forensic evidence collection and how the facility will assure ongoing competency of the nurses engaging in this practice.
The references to Rule 217.11Standards of Nursing Practice, in FAQ #1 are also applicable here. Both the nurse making assignments to other nurses [217.11(1)(S)] and the nurse accepting the assignment [217.11(1)(T)] have responsibilities to assure client safety. The nurse to whom the assignment is made must have the educational preparation, experience, knowledge, and physical and emotional ability to accept the assignment.