SECTION 225.3. Purpose

(a) The Texas Board of Nursing (BON or Board) recognizes that public preference in the provision of health care services includes a greater opportunity for clients to share with the RN in the choice and control for delivery of services in the community based setting. The Board also appreciates that the provision of health care is dynamic in nature and continually evolving. As professional nurses, regardless of practice setting, RNs are obligated to assess the nursing needs of the client, develop a plan of nursing actions, implement this plan, and evaluate the outcome. These are essential components of RN practice that identify professional nursing as a process discipline. Professional nursing while inclusive of tasks is not focused on tasks but rather on interventions or client-centered actions initiated to assist the client in accomplishing the goals defined in the nursing care plan.

(b) In the independent living environment, RNs encounter clients across the spectrum of health to illness. The primary goal is to assist the choice of the client to achieve the most integrated setting/least restrictive environment throughout the life span. This is regularly accomplished, in part, through the assistance of unlicensed personnel who work with the client to complete a variety of tasks on a daily basis. Some tasks that are considered nursing tasks in the acute care setting are considered support services necessary to assist the client to maintain client health, and thus the highest degree of independence and quality of life possible, in the independent living environment.

(c) The purpose of this chapter is to provide guidance to RNs which includes advanced practice registered nurses practicing in independent living environments in incorporating the use of unlicensed personnel to achieve optimal health benefits for the client. Clients in these settings have needs that may be categorized as activities of daily living (ADLs), health maintenance activities (HMAs), or nursing tasks. For some clients, ADLs and HMAs may be of a routine and supportive nature that minimizes the need for RN involvement.

(d) The RN shall collaborate with the client and/or the client's responsible adult in pursuit of the highest possible degree of independent living for the client. By adequately and accurately assessing the needs of the client in this setting, and considering the inter-related factors impacting the client's environment, the RN can effectively make decisions in utilizing unlicensed personnel to accomplish quality supportive services and care.

(e) The RN nurse administrator or the RN who is responsible for nursing services in settings that utilize RN delegation in independent living environments shall be responsible for knowing the requirements of this rule and for taking reasonable steps to assure that registered nurse delegation is implemented and conducted in compliance with the Texas Nursing Practice Act and this chapter.

Source Note: The provisions of this §225.3 adopted to be effective February 19, 2003, 28 TexReg 1386; amended to be effective February 24, 2014, 39 TexReg 1154