Major Decisions from the Texas Board of Nursing April Meeting

There were two big decisions impacting nursing practice from the Texas Board of Nursing in the April Board meeting:

  1. A Midwife (not an Advanced Practice Nurse-Midwife) with a RN license, but acting in a Midwife role, was held to have violated the NPA with regards to documentation standards, etc. despite no action from the Midwifery Board.  This has significant implications for dually licensed individuals (such as myself – an RN/Paramedic) and it is my opinion that this is a wrong decision.  The case is not a really “clean” case for some reasons, so this may be a case of bad cases making bad law. The vote was a 7-3 with 2 members missing. Link to Final Board Order (when available).
  2. The Board eviscerated the minor incident rule in ruling that a LVN who made a dressing change, but used Coban instead of Mefix tape in contravention of the treating physicians orders, violated the nursing practice act. It is clear from the Administrative Law Judge’s (ALJ) Proposal for Decision that the LVN used what I would consider good clinical judgment in this case, only to be blamed for wounds that occurred because of actions that occurred prior to her visit. The only violation of the minimum nursing standards rule that the ALJ upheld was 217.11(1)(N) for failing to contact the physician before using Coban, which the ALJ called a minor incident. The argument by Board staff was that the minor incident rule does not apply because the actions of nurse allegedly exposed the patient to a substantial risk of harm and this takes the matter out of the minor incident rule. But then again, when does any action a nurse performs in treating a patient not expose the patient to a substantial risk of harm? In addition, the Board found that two of the conclusions of law should have supported violation of another section of the minimum nursing standards rule, 217.11(1)(D), and that this supported a violation of 301.452(b)(13).  Link to the Final Board Order.


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