What are the requirements for a nurse to give flu injections?
The laws regarding immunizations are not within the BON's authority. With regard to vaccines of any kind, an Attorney General opinion in 1981 (MW-318) determined that immunizations are preventative, thus no medical diagnosis is required or made when a person receives an immunization. Board staff recommends that a facility have standing physician delegation orders that guide the nurse when to give pneumococcal or influenza vaccines. Position Statement 15.5, Nurses with Responsibility for Initiating Physician Standing Orders, references the Texas Medical Board rules applicable to these types of orders, and provides guidance to nurses and employers on important components to include in standing delegation orders.
Board staff recommends review of documents located on our web page in "Nursing Practice" then "Scope of Practice." Among the documents in this section are rule 217.11, Standards of Nursing Practice, the Interpretive Guideline for LVN Scope of Practice Under Rule 217.11, several Frequently Asked Questions that address the LVN practice, and the Six-Step Decision-Making Model for Determining Nursing Scope of Practice.
As the BON does not regulate specific practices or practice settings, you may wish to check with the Department of State Health Services [DSHS]. The number for the Immunizations Branch is 800-252-9152. The DSHS web site is http://www.dshs.state.tx.us.
Can an RN delegate vaccination administration?
Both the advanced practice registered nurse and the registered nurse delegate in the same manner - through the rules in Chapters 224 and 225. The Delegation Resource Packet contains access to the delegation rules in Chapters 224 and 225 as well as other resources related to delegation.
In general, vaccination administration would be prohibited from delegation by an RN to unlicensed assistive personnel (UAP). The delegation rules in Chapter 224 are more restrictive than the rules in Chapter 225. All medication administration, and routes of medication administration are prohibited from delegation in the acute delegation rules with the exception of the medication aide permit holder. An RN cannot delegate the injectable route to a medication aide with the exception of insulin in compliance with rule 224.9. Rule 225.12 (5) specifically prohibits delegation of injectable routes used for vaccination.
RNs may supervise UAPs performing tasks delegated by other licensed healthcare providers. In these situations, an RNs accountability is to verify the training of the UAP, verify the UAP can perform the task safely, and provide adequate supervision of the UAP. If the RN cannot verify all of these responsibilities, the RN must notify the delegating licensed healthcare provider that the UAP is not capable of performing the task (rule 224.10 or 225.13)
Does a nurse’s scope of practice change in a pandemic?
A nurse’s scope of practice is related to the nurse’s education, experience, knowledge, and physical and emotional ability. In addition, the practice setting of the nurse influences the nurse’s scope of practice through the policies and procedures as these reflect the regulations for the practice setting. Nurses follow the Nursing Practice Act (NPA) and Board rules as well as any other laws, rules, or regulations affecting the nurse’s area of practice. The Six-Step Decision-Making Model for Determining Nursing Scope of Practice guides a nurse in making good judgments about the tasks or procedures a nurse chooses to perform. Nurses have a duty to promote safety for their patients. Position Statement 15.14, Duty of a Nurse in any Practice Setting further explains the responsibility of the nurse to advocate for patient safety.
Can a nurse do a medical screening exam in the ER during a pandemic?
In the definition of nursing, found in the Nursing Practice Act section 301.002, medical diagnosis is excluded from the practice of nursing. If the purpose of a medical screening is to determine a medical diagnosis, this would be beyond the parameters of nursing practice. A nurse is required to implement measures to prevent exposure to infectious or communicable conditions [rule 217.11 (1) (O)]. One way to accomplish this standard is to identify incoming patients who might be infectious and provide them with a separate waiting area so as not to expose others to communicable conditions. When a physician is delegating to a nurse, the nurse is expected to comply with the Standards of Nursing Practice just as if performing a nursing procedure. Position Statement 15.11, Delegated Medical Acts discusses physician delegation and the role of the nurse.
Is it mandatory for a nurse to receive a flu vaccination (either the seasonal flu vaccination or the 2009 H1N1 influenza vaccination?
Nurses may choose to receive a vaccination to prevent exposing patients to the flu and to protect themselves from possible infection. A person may be contagious prior to developing symptoms with either seasonal flu or the 2009 H1N1 influenza and thus may expose others to the disease. The process for making most flu vaccines is such that individuals with egg allergies generally cannot take the injection form of vaccination. The following web sites have information on the seasonal influenza as well as on the 2009 H1N1 influenza:
- U.S. Department of Health and Human Services - Flu: http://www.flu.gov/
- Centers for Disease Control and Prevention - Influenza: http://www.cdc.gov/flu/
- Texas Department of State Health Services: http://www.dshs.state.tx.us/txflu/default.shtm
- World Health Organization - Influenza: http://www.who.int/topics/influenza/en/