Jurisprudence and Ethics for Nurses Licensed in Texas

Jurisprudence is the science or philosophy of law. The Texas Nurse Practice Act and the Texas Board of Nursing (BON) Rules and Regulations Relating to Nurse Education, Licensure, and Practice are the laws that govern the practice of nursing practice in Texas. The BON represents the people of Texas by ensuring that licensed nurses meet minimum standards of safe practice. The licensure of nurses is a requirement to protect the people of Texas and ensure safe nursing care. Your nursing practice is directly affected by your ability to make an informed decision within the parameters of these laws. You can find the Nurse Practice Act and Rules and Regulations by going to the Texas BON website and clicking on the menu item Laws & Rules. The NPA stipulates that you cannot call yourself a nurse or practice in Texas without a license.

You can find the Scope and Practice information and BON position statements by going to the Texas BON of nursing website and clicking on practice. The difference between professional and vocational nursing is detailed in Table 1(NPA, 2021).

Sue works the evening shift at a nursing home at 3:30. Sue receives a call from her child's care provider, and her child is sick. She asks the charge nurses if she could check on her child. This situation conflicts with Sue's value of her child's health and her professional, ethical responsibility of fidelity in doing one's duty. If the charge nurse allows Sue to go home, this resolves her conflict. If the charge nurse does not allow Sue to go home, the conflict remains unresolved.

Mr. X's physician has asked home health care to evaluate him for home health services. It is determined that Mr. X requires client education related to his diet and medication. Physical therapy is also ordered. Mr. X allows the nurse to come but refuses physical therapy. After Mr. X refused to open the door for the therapist, the nurse and therapists arranged to go together. Mr. X continues to refuse to participate in the physical therapy regimen. This situation is an ethical conflict between fidelity and beneficence in doing one's duty to conduct a beneficial client care order and the client's autonomy in his right to choose.

Sam is a 34-year-old man with end-stage complications due to AIDs. He has been undergoing peritoneal dialysis. Recently he has decided to stop dialysis. He has informed his care providers of his decision. Sam's sister has been the strongest source of support, but she disagrees with this decision. She is convinced that improving Sam's depression will change his mind. She demands that everything be done for her brother. This situation is the conflict between Nonmaleficence in avoiding harm to the client and autonomy in the client's right to choose.

A nurse must maintain a therapeutic relationship with clients. The boundaries of this relationship include physical, sexual, emotional, or financial exploitation of the client or their family members. Because nursing involves caring for clients who may not be fully dressed, it puts them in a vulnerable situation. A nurse must promote the client's dignity, independence, and best interests. Personal gain at a client's expense is unacceptable and may be a crime (rules and regulations, 217.2).

Delegation can be a perplexing concept with multiple nuances. RNs can delegate. LVNs can supervise or assign, but they cannot delegate. APRNs must delegate tasks just as other RNs would but may not delegate as physicians do. Training is different from delegation. Your responsibility to a trainee ends when their training is complete.

The BON provides many resources about delegation on the Texas Board of Nursing website. The following is a flow chart of decision-making about delegation by RNs to unlicensed personnel for clients with acute conditions or acute care environments.

PDF Delegation-rule224

PDF Delegation-rule225

Consumers and other professionals can make complaints. Nurses have the mandated responsibility to submit a written, signed report to the BON when they have cause to suspect violations of the rules and regulations. This report may include but is not limited to:

• behaviors that may expose clients or others to unnecessary risk of harm
• unprofessional conduct by a nurse
• failure to adequately care for a client
• failure to conform to the minimum standards of acceptable nursing practice
• impairment or likely impairment of a nurses practice by chemical dependency, alcohol, or mental illness

A nursing incident-based peer review committee report satisfies the nurse's duty to report to the BON. Complaints must be in writing and signed by the complainant.

This website link provides complaint forms and explains how to file a complaint. You can also file a complaint by:

• calling the Texas board of nursing at (512)-305-7400
• mailing a complaint to the Texas board of nursing, enforcement, Suite 3406, 333 Guadalupe St., Austin, TX 78701.

Reporting minor Incidents does not enhance public protection; therefore, they should not be reported. The definition of minor incidents is in NPA 301.401 (2) and includes "conduct that does not indicate that the continuing practice of nursing by an affected nurse poses a risk of harm to the client or other person." Additional information guiding which incidents need to be reported to the BON is contained in Rule 217.16 and means conduct by a nurse that may violate the Texas Nursing Practice Act or a Board rule but does not indicate the nurse's continued practice poses a risk of harm to a client or another person. However, any error contributing to client death or serious harm is never classified as a minor incident.

A nurse may feel an obligation to a coworker not to report an incident. The reasons to make a report include but are not limited to the following:

• failure to report is a violation of the mandatory reporting requirement
• the first duty is to the clients
• the nurse may get the help they need

If you submit a complaint, you will receive periodic updates and be notified of the results.

A nurse is trusted, but the nurse is also human. That's why the nurse must be able to promptly and fully self-disclose facts, circumstances, events, errors, and omissions when such disclosure could enhance the health status of clients or the public or could protect clients or the public from unnecessary risk of harm.

Nurses have a duty to the client - that's the highest level of responsibility. Employers, other health care providers, and the nurse's interests do not outweigh this especially important responsibility. Nurses must be aware of their actions and feelings within the therapeutic relationship, identify the invisible boundaries, and act in the client's best interest.

Nursing is a position of power. We must practice nursing in an autonomous role with clients, their families, significant others, and public members during challenging times in their lives. Nurses can take advantage of vulnerable people, and we have to arm ourselves against any abuse of trust.

A nurse has a vital role in maintaining professional boundaries and must know, recognize, and maintain the professional boundaries of the nurse-client relationship. Violating professional boundaries of the nurse-client relationship includes but is not limited to physical, sexual, emotional, or financial exploitation of the client or the client's significant other.

• Nursing practice act, and nursing peer-reviewed, and nursing licensure compact. Texas occupations code and statutes regulating the practice of nursing as amended September 2021. Visit Source.
• TBN Texas Board of Nursing Rules and Regulations relating to Nurse Education, Licensure, and Practice (December 2021). Visit Source.
• TBN Texas Board of Nursing. 2019. Scope of Practice Decision‐Making Model. Visit Source.