Is there a law regarding how many patients (nurse: patient ratio) a nurse can be assigned to care for in Texas?
The Texas Board of Nursing (BON) has no authority over workplace or employment issues, such as staffing ratios. The Nursing Practice Act (NPA) and Board Rules and Regulations are written broadly to apply to nursing practice in any setting. In particular, you should familiarize yourself with the main rule applied to nursing practice, Rule 217.11, Standards of Nursing Practice. This rule provides the minimum standards nurses must meet in accepting any assignment, including floating, working short staffed and other practice situations.
- Standard 217.11(1) (B) requires the nurse to maintain a safe environment for the patient. This requirement supersedes any agency policy or physician order.
- Standard 217.11(1) (T) holds the nurse accountable to accept only those assignments that are within the nurse's education, training, and experience, as well as his or her physical and emotional ability. If a licensed nurse accepts an assignment, he or she is responsible for the care delivered.
- Standard 217.11(1) (S) applies to charge nurses or nurses who are in management positions. This standard is the "companion" standard to (1) (T), as it requires the nurse who is supervising other nurses to "make assignments" that take into account the educational preparation, knowledge, skills, and physical, mental and emotional abilities of the nurses for whom the supervisor is administratively responsible. This does not mean other nurses are working under the supervisor's license, or that the supervisor is responsible for every aspect of care delivered by other staff nurses. Assignments made to other licensed nurses do require forethought and adequate supervision.
- Standard 217.11(1) (U) holds supervisors responsible to oversee the nursing care provided by others for whom the supervisor is professionally responsible, from a licensure standpoint, the responsibility for overall patient care is the responsibility of the staff nurse accepting the assignment.
During the 2009, 81st Legislative Session, SB 476 was enacted and changed the Health and Safety Code. If you practice in a hospital, you may wish to contact the Department of State Health Services (DSHS) - Health Facility Program at 1-888-973-0022 or http://www.dshs.state.tx.us/hfp/default.shtm about the regulations for the official nurse staffing policies and plans that took effect on September 1, 2009.
You may also wish to contact various nursing specialty organizations, such as the Texas Nurses Association at 512-452-0645 or www.texasnurses.org. While the Board cannot address employment issues, specialty nursing organizations exist to serve their members and may be able to provide you with additional guidance. The Texas Hospital Association at www.tha.org or 512-465-1000 has developed a Nurse Staffing Law Toolkit that may provide nurses and hospitals with additional resource information.
If you believe, you are being asked to accept an assignment that would cause you to violate the NPA or rules, especially any of the standards of practice in Rule 217.11, you may wish to review the NPA Section 301.352 Protection for Refusal to Engage in Certain Conduct. If your facility or employer routinely utilizes at least 10 nurses, 5 of which are RNs, you may wish to consider invoking Safe Harbor. While the BON does not have authority over workplace issues, such as determining nurse: patient ratios, there are protections in both the NPA and the Safe Harbor Rule 217.20 for a nurse who declares Safe Harbor in good faith. If adverse employment action was taken against a nurse, then the nurse may choose to seek private legal counsel. Rule 217.20 (e) outlines the requirements the nurse must meet in order to secure the protections, what the protections are, and where they are listed in the Texas Occupations Code, Section 303.005.
Revised October 2009