Where can I find a list of tasks that LVNs and/or RNs can or cannot do in the State of Texas?
The Nursing Practice Act (NPA) and Board Rules are written broadly so that they can apply to nursing practice in any setting. As such, the BON does not provide lists of tasks or step-by-step procedures of how they are to be carried out by the nurse. It is up to the individual nurse, whether LVN or RN, to utilize good professional judgement in accepting any given assignment and/or performing a given procedure. The BON has no jurisdiction over facility policies, nor can we speak to civil liability issues.
One of the primary rule that applies to a nurse's clinical practice is Rule 217.11"Standards of Nursing Practice." This rule, along with the Nursing Practice Act and all Board Rules may be viewed on our web site. The standards that apply to nearly every situation include (1)(B)- "maintaining a safe environment for patients..", and Standard (1)(T) “accepting appropriate assignments”; other standards may apply depending on the situation.
In relation to nurses, the NPA (in section 301.002 "definition of professional nursing") states that professional nursing does not include "medical diagnosis or prescription of therapeutic or corrective measures." (ie: the RN may not engage in activities that require the use of independent medical judgement). Though the NPA has not yet been revised to incorporate LVNs into this definition, engaging in a task or tasks that requires independent medical judgment is also beyond the scope of practice for a LVN.
In addition to reviewing Rule 217.11, you may wish to look at the board's "Six Step Decision Making Model for Determining Nursing Scope of Practice". This is a flow chart of questions to help the nurse walk through the decision-making process. (Look under "Scope of Practice" on the Nursing Practice Information Page.)
One of the questions in the six step decision making model asks if there is precedent for RNs or LVNs engaging in a given practice. You may wish to check nursing literature, as well as contacting the national nursing organization related to the specialty nursing area in question to see if they endorse RN's and/or LVNs engaging in a given practice.
In addition, some acts may be performed as Delegated Medical Acts. The rules related to this are in the Board of Medical Examiner's Rule 193; however, we do have Position Statement 15.11 "Delegated Medical Acts" that you can view by clicking on "Practice Issues" on the web page when you go through the Table of Contents. Your facility's policy and procedure would also have to permit a given practice.
Neither facility policy nor MD order can discharge the nurse's responsibility for assuring patient safety, or for complying with all of the other rules and requirements in the Nursing Practice Act. A nurse may refuse to engage in any activity that the nurse, in good faith, believes may cause him/her to violate one or more provisions of the NPA and board rules (NPA, Section 301.352). Also see the "Safe Harbor" form on our web page under "Forms" and Rule 217.20 for more information.