| (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.
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