Q: I am a registered nurse in the State of Texas. I have accepted a job working in an orthopedic surgeon's office where my duties will include performing X-rays. I think there is a rule about RNs doing X-rays but I cannot find it. Do I need to attend a special certification course? Are there different requirements for hospitals, urgent care centers, or other types of practice settings?
A: Rule 217.14 Registered Nurses Performing Radiologic Procedures is the Board's rule applicable to your question. According to this rule, if a RN is employed in a practice setting that is a Medicare-approved provider or that is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the RN is not required to register with the Board. Any of the Board Rules may be accessed and printed from the web page by clicking on the Rules and Regulations link http://www.bon.state.tx.us/nursinglaw/rr.html.
If the nurse's practice setting does not have Medicare or JCAHO oversight as noted in the rule, then the registration requirement does apply, and the nurse must print out the registration form http://www.bon.state.tx.us/olv/pdfs/rad_appl.pdf and submit it to the Board. There is no cost for registering. Changes to the information provided on the application, such as new director or radiologic services, must be corrected within 30 days of the change by submitting a new application.
Rule 217.14 also references other laws outside of the BON's jurisdiction. These laws require a RN to demonstrate competency in performing radiologic procedures, but do not require the RN to also be a radiologic technologist/technician. The law does require a licensed vocational nurses (LVN) to become a certified radiologic technologist/technician in order to perform X-rays.
The statutes specifying requirements to perform x-rays are in the Texas Occupations Code under the Medical Radiological Technologists Section 601.00 http://tlo2.tlc.state.tx.us/statutes/oc.toc.htm. Applicable sections in Texas Occupations Code, Chapter 601.00 include, §601.151, 601.154(1)-(2), §601.201(a)-(b), §601.251(1)-(5), and §601.253(a)-(b).
The Department of State Health Services (DSHS) also has a rule applicable to RNs performing X-rays in 25 Texas Administrative Code, Part 1, Chapter 143, Rule 143.20. Staff recommend checking with the Dept of State Health Services for interpretation of the above noted statutes and rules relating to radiologic procedures. The contact information for the Medical Radiologic Technologist (MRT) information may be found on the Department of State Health Services web page at http://www.dshs.state.tx.us. In the upper left hand corner of the DSHS home page, click on "Find Services" and then "Programs by Health Topic." The radiology information is under "M" (for "MRT") http://www.dshs.state.tx.us/healthtopics/letterquery.asp?name=m. The phone number for the department is listed as 512-834-6617.
Some radiologic procedures may be considered delegated medical acts. BON staff recommend caution when performing a task as a delegated medical act. Delegated medical acts do not diminish the responsibility in any way of the nurse to adhere to the Boards Standards of Nursing Practice, Rule 217.11. Included in Rule 217.11 are standards requiring a nurse to maintain client safety, accept assignments within the nurse's knowledge/skills/abilities, and seek instruction and maintaining competency in tasks performed in any practice setting. [§217.11(1): (B), (G), (R) and (T)].
For general information on nurses practicing in the area of radiology, staff recommend contacting professional nursing organizations, such as the American Radiological Nurses Association at http://www.rsna.org or other nursing organizations related to a nurses’s specialty practice setting. National patient safety organizations may also provide resource information for national best-practice guidelines in specific practice settings for specific procedures. Examples include:
- Agency for Healthcare Research and Quality: http://www.ahrq.gov/
- National Quality Measures Clearinghouse: http://www.qualitymeasures.ahrq.gov/
- Institute for Safe Medication Practices: http://www.ismp.org/
- Occupational Safety and Health Administration: http://www.osha.gov/
- Institute of Medicine: http://www.iom.edu/