Current through Reg. 50, No. 13; March 28, 2025
(a) Each individual
who seeks to practice nursing in Texas must possess current fitness to
practice. This requirement includes all individuals seeking to obtain or retain
a license or privilege to practice nursing in Texas and applies in all
eligibility and disciplinary matters. Each individual has a duty to
self-evaluate to ensure that he/she is fit to practice before providing nursing
care.
(b) An individual's fitness
to practice will be determined by evaluating the individual's ability to
consistently comply with the requirements of the Nursing Practice Act, the
Board's rules and regulations, and generally accepted standards of nursing
practice. An individual's fitness to practice may be subject to Board review
due to an individual's substance use disorder; possession, abuse, or misuse of
alcohol or drugs, prescribed or otherwise; or physical or mental health
condition. This is not an exhaustive list. If an individual exhibits any
conduct that may prevent him/her from practicing nursing with reasonable skill
and safety, the Board will review the individual's conduct to determine if
he/she possesses current fitness to practice.
(c) Evaluations. If an individual exhibits
conduct that raises questions about his/her fitness to practice, the Board may
require the individual to undergo a physical and/or psychological evaluation
that meets the criteria of the Occupations Code §
301.4521 and §
213.33 of this chapter (relating
to Factors Considered for Imposition of Penalties/Sanctions). Pursuant to
§301.4521, an individual subject to this rule is responsible for paying
the costs of the evaluation. Utilizing the results of the evaluation and the
individualized facts of the case, the Board may deny licensure (including
renewal, reinstatement/reactivation, or the return to direct patient care from
a limited license); suspend or revoke the individual's license or privilege to
practice nursing in this state; or impose probationary conditions or
restrictions on the individual's ability to practice nursing in this
state.
(d) Substance Use Disorders
and Abuse/Misuse of Alcohol or Drugs.
(1)
Individuals who have been diagnosed, treated, or hospitalized for a substance
use disorder that may impair their ability to practice nursing safely, will, at
a minimum, be required to demonstrate sobriety and abstinence from drugs and
alcohol for a minimum of twelve consecutive months, through verifiable and
reliable evidence, in order to obtain or retain licensure. Verifiable and
reliable evidence of sobriety and abstinence from drugs and alcohol may include
evidence of the completion of inpatient, outpatient, or aftercare treatment,
random drug screens, individual or group therapy, and/or support group
attendance. Depending upon the individualized facts of each case, an individual
may be required to establish this period of sobriety and abstinence prior to
being permitted to practice nursing in this state. If appropriate, based upon
the individualized facts of the case, an individual may also be eligible to
obtain or retain licensure and practice nursing under an encumbered license
with conditions/restrictions determined by the Board or through participation
in a Board-approved peer assistance program created pursuant to the Texas
Health and Safety Code Chapter 467 or other lawfully authorized peer assistance
program. Licensure conditions/restrictions may include the completion of
inpatient, outpatient, or aftercare treatment, random drug screens, individual
or group therapy, and/or support group attendance. The outcome of any
particular case will be based upon an evaluation of the individualized factors
of the case and the potential risk of harm the individual's practice may pose
to patients/clients and/or the public.
(2) Individuals who have not been diagnosed,
treated, or hospitalized for a substance use disorder, but have nonetheless
exhibited behaviors raising concerns about the individual's ability to practice
nursing with reasonable skill and safety due to the possession, misuse, or
abuse of alcohol or drugs, prescribed or otherwise, including related criminal
conduct, may be required to demonstrate sobriety and abstinence from drugs and
alcohol for a minimum of twelve consecutive months, through verifiable and
reliable evidence, in order to obtain or retain licensure. Verifiable and
reliable evidence of sobriety and abstinence from drugs and alcohol may include
evidence of the completion of inpatient, outpatient, or aftercare treatment,
random drug screens, individual or group therapy, and/or support group
attendance. If appropriate, and depending upon the individualized facts of each
case, an individual may be eligible to obtain or retain licensure and practice
nursing under an encumbered license with conditions/restrictions determined by
the Board, which may include the completion of inpatient, outpatient, or
aftercare treatment, random drug screens, individual or group therapy, and/or
support group attendance. The outcome of any particular case will be based upon
an evaluation of the individualized factors of the case and the potential risk
of harm the individual's practice may pose to patients/clients and/or the
public.
(3) An individual's prior
substance use disorder diagnosis or history of prior criminal conduct involving
drugs or alcohol, prescribed or otherwise; or misuse or abuse of alcohol or
drugs, prescribed or otherwise; will be considered by the Board only to the
extent that it may be indicative of the individual's current lack of fitness to
practice nursing.
(e)
Mental Health Conditions and Diminished Capacity.
(1) Individuals who have been diagnosed,
treated, or hospitalized for a mental health condition that may impair their
ability to practice nursing safely, will, at a minimum, be required to
demonstrate controlled behavior and consistent compliance with recommended
treatment, including compliance with a prescribed medication regime, for a
reasonable amount of time, through verifiable and reliable evidence, in order
to obtain or retain licensure. Depending upon the individualized facts of each
case, an individual may be required to establish controlled behavior and
compliance with recommended treatment, including compliance with a prescribed
medication regime, prior to being permitted to practice nursing in this state.
If appropriate, and depending upon the individualized facts of the case, an
individual may also be eligible to obtain or retain licensure and practice
nursing under an encumbered license with conditions/restrictions determined by
the Board or through participation in a Board-approved peer assistance program
created pursuant to the Texas Health and Safety Code Chapter 467. The outcome
of any particular case will be based upon an evaluation of the individualized
factors of the case and the potential risk of harm the individual's practice
may pose to patients/clients and/or the public.
(2) Individuals who have not been diagnosed,
treated, or hospitalized for a mental health condition, but have nonetheless
exhibited behaviors raising concerns about the individual's fitness to practice
due to a mental health condition or diminished capacity may be required to
demonstrate controlled behavior and compliance with recommended treatment,
including compliance with a prescribed medication regime, for a reasonable
amount of time, through verifiable and reliable evidence, in order to obtain or
retain licensure. If appropriate, and depending upon the individualized facts
of each case, an individual may also be eligible to obtain or retain licensure
and practice nursing under an encumbered license with conditions/restrictions
determined by the Board. The outcome of any particular case will be based upon
an evaluation of the individualized factors of the case and the potential risk
of harm the individual's practice may pose to patients/clients and/or the
public.
(3) An individual's prior
mental health diagnosis or behavioral history will be considered by the Board
only to the extent that it may be indicative of the individual's current lack
of fitness to practice nursing.
(f) Other Medical Conditions.
(1) The Board recognizes that individuals may
have a variety of medical conditions that require medical treatment and/or a
medication regime that includes prescription drugs. Although authorized by law
and medically necessary, prescription drugs may affect an individual's fitness
to practice. An individual must be able to function safely while under the
effects of prescription drugs. An individual who abuses his/her prescription
drugs or who has been unable to stabilize the synergistic effect of his/her
medications may not possess current fitness to practice. Further, some
prescription medications may cause side effects that affect an individual's
fitness to practice, even when taken properly. In some cases, an individual's
physical condition may prevent the individual from practicing nursing safely.
In addition to an individual's medication regime, the Board will review an
individual's behavior, diagnosis/condition, and treatment plan to determine if
he/she possesses current fitness to practice. Based upon the individualized
facts of the case, including the results of a required evaluation, if any, the
Board may deny licensure (including renewal, reinstatement/reactivation, or the
return to direct patient care from a limited license); suspend or revoke the
individual's license or privilege to practice nursing in this state; or impose
probationary conditions or restrictions on the individual's ability to practice
nursing in this state, including limiting the practice setting to one in which
the individual is safe to practice nursing.
(2) An individual's prior medical condition
and/or diagnosis will be considered by the Board only to the extent that it may
be indicative of the individual's current lack of fitness to practice
nursing.
(g) Authority
of Executive Director. In eligibility and disciplinary matters involving an
individual's fitness to practice, the Executive Director may:
(1) review information submitted by the
individual and materials and information gathered or prepared by Board Staff;
including evidence of the individual's safe practice, compliance with the
Nursing Practice Act, Board rules and regulations, and generally accepted
standards of nursing practice; verification of compliance with treatment; and
evidence of sobriety;
(2) identify
any deficiencies in the information necessary for a determination regarding the
individual's current fitness to practice;
(3) close any eligibility file in which the
individual seeking licensure has failed to respond to a request for information
from the Board or to a proposal for denial of licensure within 60 days of the
request or proposed denial, as applicable;
(4) approve an individual's eligibility for
licensure, enter eligibility orders as authorized in §
211.7(relating to Executive
Director) of this title, and approve renewals, without Board ratification, when
the evidence is clearly insufficient to support denial of licensure;
and
(5) propose eligibility and
disciplinary orders in eligibility, disciplinary, and renewal matters
consistent with the Board's rules and regulations and the interests of public
safety and enter disciplinary orders as authorized in §
211.7 of this title.
(h) The following eligibility and
disciplinary sanction policies, as applicable, shall be used by the Executive
Director, SOAH, and the Board in evaluating the impact of criminal conduct on
nurse licensure in eligibility and disciplinary matters:
(1) Sanctions for Behavior Involving Fraud,
Theft, and Deception, approved by the Board and published on August 28, 2015,
in the
Texas Register and available on the Board's website at
http://www.bon.state.tx.us/disciplinaryaction/dsp.html;(2) Sanctions for Behavior Involving Lying
and Falsification, approved by the Board and published on August 28, 2015, in
the
Texas Register and available on the Board's website at
http://www.bon.state.tx.us/disciplinaryaction/dsp.html;(3) Sanctions for Sexual Misconduct approved
by the Board and published on February 22, 2008, in the
Texas
Register (33 TexReg 1649) and available on the Board's website at
http://www.bon.state.tx.us/disciplinaryaction/dsp.html;
and
(4) Sanctions for Substance Use
Disorders and Other Alcohol and Drug Related Conduct, approved by the Board and
published on August 28, 2015, in the
Texas Register and
available on the Board's website at
http://www.bon.state.tx.us/disciplinaryaction/dsp.html.
