“Mandatory overtime" means a requirement that a nurse work hours or days that are in addition to the hours or days scheduled [Texas Health and Safety Code §258.002] and does not pertain to situations when a nurse’s relief does not arrive on time following his or her scheduled shift. Do you have a standing delegation order, if applicable? These resources include: Board Staff also recommend review of the Texas Medical Board Rule 193.17, entitled Nonsurgical Medical Cosmetic Procedures, that addresses the rules related to physician delegation of nonsurgical medical cosmetic procedures. Does the BON have a position statement that addresses the RN’s role in the management of an unwitnessed cardiac or respiratory arrest in a long-term care facility? The LVN may assist with the development of the IHP but is not permitted to write it independently. .”, The Nursing Practice Act (NPA) and Board rules require licensed vocational nurse (LVN) practice to be performed under the supervision of a registered nurse (RN), advanced practice registered nurse (APRN), physician, physician assistant (PA), podiatrist, or dentist [NPA Section 301.353 & Board Rule 217.11 (2)]. The proximity of supervision is not defined in rule. Below are some examples of what you should consider when evaluating whether a cosmetic procedure is within your scope of practice: An LVN should not perform a cosmetic procedure if the LVN lacks the necessary educational preparation, knowledge, competency, or skill to safely perform the procedure; lacks an order for the procedure; or lacks appropriate supervision. Ideally, this ratio could be set at one nurse for three patients, however in our current practices a nurse may be required to care for seven patients at a time. The Nursing Practice Act and Board rules are written broadly to apply to all nurses, including advanced practice registered nurses (APRNs), across all practice settings.  Neither are prescriptive to specific tasks or services APRNs may perform or provide.  Likewise, they do not address specific practice settings for specific categories of APRNs. One example of this may be performing a lower leg wax for a client who has diabetes and peripheral neuropathy; this client may not be able to feel if the wax is too hot and there may be associated burns and a poor outcome. For complete information, see Texas Health & Safety Code Chapter 168. 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. Position Statement 15.14 (Duty of a Nurse in Any Practice Setting) further clarifies a nurse's duty, regardless of the level of nursing licensure held. Texas bill could mandate lower nurse-to-patient ratios,